Resolving the Enigma of the Mesoamerican Nephropathy: A Research Workshop Summary
Resolving the Enigma of the Mesoamerican Nephropathy: A Research Workshop Summary
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DOI：
10.1053/j.ajkd.2013.08.014
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发表时间：
2014-03-01
影响因子：
13.2
通讯作者：
Wegman, David H.
中科院分区：
文献类型：
--
作者：
Wesseling, Catharina;Crowe, Jennifer;Wegman, David H.
2012年11月在哥斯达黎加召开了第一届中美洲肾病（MEN）国际研究研讨会，讨论如何确定MEN的范围和程度，检查相关的因果假设，并集中精力控制或消除疾病负担。MeN描述了一种主要在年轻男性甘蔗切割工中观察到的起源不明的慢性肾脏疾病的毁灭性流行病。MeN的原因仍不确定;然而，迄今为止，最强有力的假设是职业性热应激和水和溶质损失的反复发作，可能与其他潜在的风险因素相结合，如非甾体抗炎药和其他肾毒性药物的使用，无机砷，钩端螺旋体病或农药。在研究讲习班上，提出了临床和流行病学病例定义，以促进公共卫生和研究工作。研讨会提出的建议包括测量工人的工作量、热量以及水和溶质流失;量化饮用水和食物中的肾毒性剂;使用早期肾损伤的生物标志物来探索MeN的潜在原因;以及描述社会和工作条件以及有效收集暴露数据和个人风险因素的方法。详细介绍了不同人群研究设计的优缺点。为了阐明MeN的病因，采用前瞻性队列设计的多国研究，最好是整合生态系统健康方法，被认为是最有前途的。此外，还讨论了遗传、实验和机制方法和设计，特别是肾活检分析、动物模型研究、生物标志物进展、遗传和表观遗传研究、生物学和人口统计学数据和/或标本的共同登记和储存库以及潜在慢性肾脏疾病实验研究的其他领域的需求。最后，为了加强在MeN方面的国际合作，研讨会与会者同意建立一个研究联合会，将这些中美洲努力与世界各地的其他努力联系起来。(c)2014年由国家肾脏基金会，Inc.
The First International Research Workshop on Mesoamerican Nephropathy (MeN) met in Costa Rica in November 2012 to discuss how to establish the extent and degree of MeN, examine relevant causal hypotheses, and focus efforts to control or eliminate the disease burden. MeN describes a devastating epidemic of chronic kidney disease of unknown origin predominantly observed among young male sugarcane cutters. The cause of MeN remains uncertain; however, the strongest hypothesis pursued to date is repeated episodes of occupational heat stress and water and solute loss, probably in combination with other potential risk factor(s), such as nonsteroidal anti-inflammatory drug and other nephrotoxic medication use, inorganic arsenic, leptospirosis, or pesticides. At the research workshop, clinical and epidemiologic case definitions were proposed in order to facilitate both public health and research efforts. Recommendations emanating from the workshop included measuring workload, heat, and water and solute loss among workers; quantifying nephrotoxic agents in drinking water and food; using biomarkers of early kidney injury to explore potential causes of MeN; and characterizing social and working conditions together with methods for valid data collection of exposures and personal risk factors. Advantages and disadvantages of different population study designs were detailed. To elucidate the etiology of MeN, multicountry studies with prospective cohort design, preferably integrating an ecosystem health approach, were considered the most promising. In addition, genetic, experimental, and mechanistic methods and designs were addressed, specifically the need for kidney biopsy analysis, studies in animal models, advances in biomarkers, genetic and epigenetic studies, a common registry and repository of biological and demographic data and/or specimens, and other areas of potential chronic kidney disease experimental research. Finally, in order to improve international collaboration on MeN, workshop participants agreed to establish a research consortium to link these Mesoamerican efforts to other efforts worldwide. (c) 2014 by the National Kidney Foundation, Inc.