Histopathology of chronic kidney disease of unknown etiology in Salvadoran agricultural communities

Laura López-Marín; Yudit Chávez Muñoz; Xenia A García Ortiz; Walter M Flores Flores; Yesenia M García Zamora; Raúl Herrera Valdés; Miguel Almaguer López; Carlos M Orantes Navarro; Denis Calero Brizuela; Héctor D Bayarre Vea; Juan Carlos Amaya Rodríguez; Salvador Magaña Mercado; Paul A Espinoza Madrid; Lisbeth Serpas

2014, Number 2

MEDICC Review 2014; 16 (2)

Histopathology of chronic kidney disease of unknown etiology in Salvadoran agricultural communities

López-Marín L, Chávez MY, García OXA, Flores FWM, García ZYM, Herrera VR, Almaguer LM, Orantes NCM, Calero BD, Bayarre VHD, Amaya RJC, Magaña MS, Espinoza MPA, Serpas L

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ABSTRACT

Introduction: For at least a decade, a chronic kidney disease unassociated with diabetes mellitus, hypertension or any of the more common traditional causes, has been reported in Salvadoran agricultural communities.
Objetive: Characterize histopathology of chronic kidney disease of unknown etiology in patients from Salvadoran agricultural communities, describe renal damage associated with each disease stage, and assess associations between histopathological alterations and sociodemographic variables.
Methods: The study involved 46 patients of both sexes, aged ≥ 18 years. After clinical, laboratory and imaging examinations, kidney biopsies were performed and renal tissue assessed for interstitial fibrosis, tubular atrophy, interstitial inflammatory infiltration, sclerosis, increase in glomerular size and extraglomerular vascular lesions (according to the Banff 97 classifi cation used for kidney transplant rejection). Special staining was done: Schiff periodic acid, Masson trichrome and methenamine silver. Immunofl uorescence techniques were used to evaluate IgA, IgG, IgM, complement C1q and C3, fibrin, and kappa and lambda light chain deposits.
Results: The main findings were interstitial fibrosis and tubular atrophy with or without inflammatory monocyte infiltration. In addition, generalized sclerosis, increased glomerular size, collapse of some glomerular tufts, and lesions of extraglomerular blood vessels (such as intimal proliferation and thickening and vacuolization of the tunica media) were observed. Interstitial fibrosis and glomerulosclerosis were associated with male sex. Sugarcane workers showed more interstitial fi brosis and tubular atrophy and less glomerulomegaly than other occupational groups.
Conclusion: The morphological pattern in all biopsies was one of chronic tubulointerstitial nephropathy with secondary glomerular and vascular damage, in different stages of evolution of chronic kidney disease, independent of age, sex or occupation.

REFERENCES

National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classifi cation, and stratifi cation. Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1–266.
Grollman AP, Shibutani S, Moriya M, Miller F, Wu L, Moll U, et al. Aristolochic acid and the etiology of endemic (Balkan) nephropathy. Proc Natl Acad Sci U S A. 2007 Jul 17;104(29):12129–34.
Bamias G, Boletis J. Balkan nephropathy: evolution of our knowledge. Am J Kidney Dis. 2008 Sep;52(3):606–16.
de Jonge H, Vanrenterghem Y. Aristolochic acid: the common culprit of Chinese herbs nephropathy and Balkan endemic nephropathy. Nephrol Dial Transplant. 2008 Jan;23(1):39–41.
Grollman AP, Jelaković B. Role of environmental toxins in endemic (Balkan) nephropathy. October 2006, Zagreb, Croatia. J Am Soc Nephrol. 2007 Nov;18(11):2817–23.
Chandrajith R, Nanayakkara S, Itai K, Aturaliya TN, Dissanayake CB, Abeysekera T, et al. Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: geographic distribution and environmental implications. Environ Geochem Health. 2011 Jun;33(3):267–78.
Torres C, Aragón A, González M, López I, Jakobsson K, Elinder CG, et al. Decreased kidney function of unknown cause in Nicaragua: a community-based survey. Am J Kidney Dis. 2010 Mar;55(3):485–96.
O’Donnell JK, Tobey M, Weiner DE, Stevens LA, Johnson S, Stringham P, et al. Prevalence of and risk factors for chronic kidney disease in rural Nicaragua. Nephrol Dial Transplant. 2011 Sep;26(9):2798–805.
Orantes CM, Herrera R, Almaguer M, Brizuela EG, Hernández CE, Bayarre H, et al. Chronic kidney disease and associated risk factors in the Bajo Lempa region of El Salvador: Nefrolempa study, 2009. MEDICC Rev. 2011 Oct;13(4):14–22.
Nanayakkara S, Komiya T, Ratnatunga N, Senevirathna ST, Harada KH, Hitomi T, et al. Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka. Environ Health Prev Med. 2012 May;17(3):213–21.
Wijkström J, Leiva R, Elinder CG, Leyva S, Trujillo Z, Trujillo L, et al. Clinical and pathological characterization of Mesoamerican nephropathy: a new kidney disease in Central America. Am J Kidney Dis. 2013 Nov;62(5):908–18.
Athuraliya NT, Abeisekera TD, Amerasinghe PH, Kumarasiri R, Bandara P, Karunaratne U, et al. Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney Int. 2011 Dec;80(11):1212–21.
Defi nition and classifi cation of CKD. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013 Jan;3(1 Suppl):S5–14.
Herrera R, Orantes CM, Almaguer M, Alfonso P, Bayarre HD, Leiva IM, et al. Clinical characteristics of chronic kidney disease of nontraditional causes in Salvadoran farming communities. MEDICC Rev. 2014 Apr;16(2):39–48.
Racusen LC, Solez K, Colvin RB, Bonsib SM, Castro MC, Cavallo T, et al. The Banff 97 working classifi cation of renal allograft pathology. Kidney Int. 1999 Feb;55(2):713–23.
Vivette D, DAgatti, Jennette JC, Silva FG. Non neoplastic of kidney diseases. Atlas of non tumour pathology. Washington, D.C: The American Registry of Pathology; 2005. Chapter 7. p. 163.
Nachman PH, Jennette JC, Falk RJ. Primary Glomerular Disease. In: Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu ASL, Brenner BM, editores. Brenner and Rector’s The Kidney. 9th ed. Philadelphia: Elsevier; 2011. p. 1154–61.
Taal MW. Risk Factors and Chronic Kidney Disease. In: Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu ASL, editors. Brenner & Rector’s The Kidney. 9th ed. Philadelphia: Elsevier Inc; 2012. p. 1111–7.
Hoy WE, Hughson MD, Bertram JF, Douglas- Denton R, Amann K. Nephron number, hypertension, renal disease and renal failure. J Am Soc Nephrol. 2005 Sep;16(9):2557–64.
Keller G, Zimmer G, Mall G, Ritz E, Amann K. Nephron number in patients with primary hypertension. N Engl J Med. 2003 Jan 9;348(2):101–8.
Hoy WE, Hughson MD, Singh GR, Douglas- Denton R, Bertram JF. Reduced nephron number and glomerulomegaly in Australian Aborigines: a group at high risk for renal disease and hypertension. Kidney Int. 2006 Jul;70(1):104–10.
Brenner BM, Lawler EV, Mackenzie HS. The hyperfi ltration theory: a paradigm shift in nephrology. Kidney Int. 1996 Jun;49(6):1774–7.
Robins SL, Cotran RS, Kumar V, Collins T. Patología estructural y funcional. Buenos Aires: Editorial Interamericana; 2006. Chapter 14. p. 529. Spanish.
Jayasumana MACS, Paranagama PA, Amarasinghe MD, Wijewardane KMRC, Dahanayake KS, Fonseka SI, et al. Possible link of chronic arsenic toxicity with chronic kidney disease of unknown etiology in Sri Lanka. J Nat Sci Res. 2013;3(1):64–73.
Wanigasuriya KP, Peiris-John RJ, Wickremasinghe R. Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause? BMC Nephrol. 2011 Jul 5;12:32.
Cramér K, Goyer RA, Jagenburg R, Wilson MH. Renal ultraestructural, renal function, and parameters of lead toxicity in workers with different periods of lead exposure. Br J Ind Med. 1974 Apr;31(2):113–27.