Investigating Possible Infectious Causes of Chronic Kidney Disease of Unknown Etiology in a Nicaraguan Mining Community
Investigating Possible Infectious Causes of Chronic Kidney Disease of Unknown Etiology in a Nicaraguan Mining Community
复制标题
调查尼加拉瓜矿区病因不明的慢性肾病的可能感染原因
DOI：
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发表时间：
2019
影响因子：
3.3
通讯作者：
D. Brooks
中科院分区：
文献类型：
--
作者：
W. K. Yih;M. Kulldorff;D. Friedman;J. Leibler;J. J. Amador;Damaris López;R. Galloway;Oriana Ramirez;A. Riefkohl;D. Brooks
抽象的。一种病因不明的慢性肾病（CKDu）正在导致中美洲的工人死亡。职业热应激被认为起着重要作用。钩端螺旋体病和汉坦病毒被认为是其他可能的危险因素。在尼加拉瓜采矿社区的一项病例对照研究中，对成年人进行了结构化调查，并采集了生物测量值和样本。分析血清中的钩端螺旋体和汉坦病毒抗体。在进行统计分析之前，经过委员会认证的肾病专家根据血清肌酐和其他实验室值确定了最终病例和对照状态。通过逻辑回归进行多变量分析。在敏感性分析中，病例仅限于过去 3 年诊断为 CKDu 的病例。在 320 名符合条件的参与者中，112 名被归类为推定病例，176 名被归类为对照，32 名被归类为不确定病例。曾从事采矿或建筑工作的人的 CKDu 风险比其他参与者高 4.4 倍（比值比 = 4.44，95% CI：1.96–10.0，P = 0.0003）。 320 名参与者中有八十三名 (26%) 的至少一种测试的钩端螺旋体菌株呈血清阳性。没有发现钩端螺旋体病或汉坦病毒与 CKDu 之间存在因果关系的证据。敏感性分析提供了一些证据，反对钩端螺旋体病或汉坦病毒在几年内导致 CKDu 的假设。主要限制是无法确定感染和 CKDu 发病的绝对或相对时间。前瞻性队列设计，通过几年内重复收集标本，可以对感染作为 CKDu 的潜在病原体产生更清晰的答案。
Abstract. A chronic kidney disease of unknown etiology (CKDu) has been killing workers in Central America. Occupational heat stress is thought to play an important role. Leptospirosis and hantavirus have been suggested as additional possible risk factors. In a case–control study in a Nicaraguan mining community, a structured survey was administered to adults, and biological measurements and specimens were taken. Serum was analyzed for antibodies to Leptospira and hantavirus. Before statistical analysis, a board-certified nephrologist determined final case and control status based on serum creatinine and other laboratory values. Multivariable analysis was by logistic regression. In sensitivity analyses, cases were restricted to those diagnosed with CKDu in the previous 3 years. Of 320 eligible participants, 112 were classified as presumptive cases, 176 as controls and 32 as indeterminant. The risk of CKDu in those ever having worked in mining or construction was 4.4 times higher than in other participants (odds ratio = 4.44, 95% CI: 1.96–10.0, P = 0.0003). Eighty-three (26%) of the 320 participants were seropositive for at least one tested strain of Leptospira. No evidence of a causal link between leptospirosis or hantavirus and CKDu was found. The sensitivity analyses provide some evidence against the hypotheses that leptospirosis or hantavirus leads to CKDu within a few years. A major limitation was the impossibility of determining the absolute or relative timing of infection and CKDu onset. A prospective cohort design, with repeated collection of specimens over several years, could yield clearer answers about infections as potential etiologic agents in CKDu.
影响因子：
39.2
作者：
Levey AS;Stevens LA;Schmid CH;Zhang YL;Castro AF 3rd;Feldman HI;Kusek JW;Eggers P;Van Lente F;Greene T;Coresh J;CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
DOI：
10.1053/j.ajkd.2008.11.034
发表时间：
2009-06
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Coca SG;Yusuf B;Shlipak MG;Garg AX;Parikh CR
通讯作者：
Parikh CR