Chronic Kidney Disease of unknown cause (CKDu) in disadvantaged communities in low-and-middle income countries (LMICs)

在中低收入国家(LMIC)的农业社区中，有一种以肾小管间质慢性肾脏病(CKD)为主的流行病。这一点最近发表在《科学》杂志上，报道了一些目前申请者之前的工作。虽然目前尚不清楚是否存在统一的潜在病因，但这些情况已被统称为不明原因的CKD(CKDu)。据估计，在过去20年里，CKDu导致了LMIC中数万到数十万名年轻男女的过早死亡。因此，迫切需要了解这些疾病的病因学和病理生理学(S)，并制定预防措施。目前已知CKDU存在于中美洲，主要影响男性农村农业工人。它也可能发生在世界其他热带/亚热带地区，但没有标准化数据可供比较，也不知道它影响了哪些种群亚群。获得这些信息是发现慢性肾衰病因(S)的关键一步。我们最近建立了一个合作伙伴关系，涉及一个实用的方案来估计弱势社区的肾功能分布：弱势人群估计肾小球滤过率(EGFR)流行病学研究(度)。这将提供关键信息，为假说提供依据，并指导对CKDU原因的进一步研究。基金会奖将通过在三个热带/亚热带地区(亚洲、非洲和拉丁美洲)的四个中心(印度、马拉维、秘鲁和墨西哥)实施流行率调查方案(和相关的验证研究)，使这一伙伴关系取得阶段性变化，这些地区的疾病可能是地方病。这将为开展进一步的研究以发现CKDU的病因(S)，并开发预防措施提供基础。

There is an epidemic of primarily tubular-interstitial chronic kidney disease (CKD) clustering in agricultural communities in low-and-middle income countries (LMICs). This was featured recently in Science which reported previous work of some of the current applicants. Although it is currently unclear whether there is a unified underlying aetiology, these conditions have been collectively termed CKD of unknown cause (CKDu). CKDu is estimated to have led to the premature deaths of tens to hundreds of thousands of young men and women in LMICs over the last two decades. Thus, there is an urgent need to understand the aetiology and pathophysiology of these condition(s) and to develop preventive interventions.Currently it is known that CKDu exists in Central America and mainly affects male rural agricultural workers. It may also be occurring in other tropical/subtropical parts of the world, but standardized data are not available for comparison, and also it is not known which population subgroups it affects. Obtaining this information is an essential step towards discovering the cause(s) of CKDu.We have recently established a partnership involving a practical protocol to estimate distributions of renal function in disadvantaged communities: the Disadvantaged populations estimated glomerular filtration rate (eGFR) epidemiology study (DEGREE). This will provide key information to inform hypotheses and to guide further research into the causes of CKDu. The Foundation Award will enable this partnership to make a step-change by implementing the prevalence survey protocol (and a related validation study) in four centres (India, Malawi, Peru, Mexico) in three tropical/subtropical regions (Asia, Africa, and Latin America) where the disease is likely to be endemic. This will provide the basis for developing further studies to discover the cause(s) of CKDu, and developing interventions to prevent it.