Clinical Evidence of Acute Mesoamerican Nephropathy
Clinical Evidence of Acute Mesoamerican Nephropathy
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DOI：
10.4269/ajtmh.17-0260
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Murray, Kristy O.
中科院分区：
文献类型：
--
作者：
Fischer, Rebecca S. B.;Mandayam, Sreedhar;Murray, Kristy O.
中美洲肾病（Mesoamerican nephropathy，MeN）是中美洲一种流行的不明原因肾病，主要影响年轻健康的个体。其病因是一个谜，需要迫切调查。Larvastatin被描述为一种慢性肾脏疾病（CKD），尚未描述急性临床情况。对早期疾病过程的了解可以阐明病因并指导治疗和预防工作。我们试图在尼加拉瓜的高危人群中记录疑似MeN患者的最早临床体征。当地医院的医生确定了可疑病例，并记录了临床/实验室数据、人口统计学和病史。在1年的时间内，医生确定了255例肌酐升高或肌酐清除率降低的患者，大多数是年轻（中位数29岁）、男性（89.5%）。平均血清肌酐（2.0 +/-0.6 mg/dL）显示较基线增加2倍，一半患者发生2期或3期急性肾损伤。以白细胞尿（98.4%）、白细胞增多（81.4%）和嗜中性粒细胞增多（86.2%）为主。恶心（59.4%）、背痛（57.9%）、发热（54.6%）、呕吐（50.4%）、头痛（47.3%）和肌无力（45.0%）较为常见。典型的急性MeN病例表现为肌酐升高（或从基线增加>= 0.3 mg/dL或>= 1.5倍），无高血压或糖尿病，白细胞尿，以及发热、恶心或呕吐、背痛、肌无力、头痛或白细胞增多和/或嗜中性粒细胞增多中的至少两种。在8.5%的患者中记录了快速进展（中位90天）至CKD。这一证据可以作为一个敏感的和迫切需要的病例定义的基础，早期，急性MeN的疾病监测。
Mesoamerican nephropathy (MeN), an epidemic of unexplained kidney disease in Central America, affects mostly young, healthy individuals. Its etiology is a mystery that requires urgent investigation. Largely described as a chronic kidney disease (CKD), no acute clinical scenario has been characterized. An understanding of the early disease process could elucidate an etiology and guide treatment and prevention efforts. We sought to document the earliest clinical signs in patients with suspected MeN in a high-risk population in Nicaragua. Physicians at a local hospital identified suspect cases and documented clinical/laboratory data, demographics, and medical histories. Over a 1-year period, physicians identified 255 mostly young (median 29 years), male (89.5%) patients with elevated creatinine or reduced creatinine clearance. Mean serum creatinine (2.0 +/- 0.6 mg/dL) revealed a 2-fold increase from baseline, and half had stage 2 or 3 acute kidney injury. Leukocyturia (98.4%), leukocytosis (81.4%), and neutrophilia (86.2%) predominated. Nausea (59.4%), back pain (57.9%), fever (54.6%), vomiting (50.4%), headache (47.3%), and muscle weakness (45.0%) were common. A typical case of acute MeN presented with elevated (or increased >= 0.3 mg/dL or >= 1.5-fold from baseline) creatinine, no hypertension or diabetes, leukocyturia, and at least two of fever, nausea or vomiting, back pain, muscle weakness, headache, or leukocytosis and/or neutrophilia. Rapid progression (median 90 days) to CKD was recorded in 8.5% of patients. This evidence can serve as the basis of a sensitive and urgently needed case definition for disease surveillance of early-stage, acute MeN.