Acute Kidney Injury and CKD: Chicken or Egg?

Bedford, Michael; Farmer, Chris; Levin, Adeera; Ali, Tariq; Stevens, Paul E.

doi:10.1053/j.ajkd.2011.09.010

Cited by 61 publications

(45 citation statements)

References 59 publications

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“…19,20,22,25,39 Less is known about their ability to predict subclinical AKI or future CKD; repeated incidents of subclinical kidney damage may increase CKD risk, but this relationship remains unclear. 40-42 The lack of overall correlation between changes in urinary biomarkers and changes in eGFR may reflect the possibility that changes in biomarkers precede changes in eGFR. However, workers with the greatest increases in NGAL and NAG during the harvest had greater declines in eGFR.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers of Kidney Injury Among Nicaraguan Sugarcane Workers

Laws

Brooks

Amador

et al. 2016

American Journal of Kidney Diseases

102

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Background In Central America, an epidemic of chronic kidney disease of unknown etiology disproportionately affects young, male agricultural workers. Study Design Longitudinal cohort study. Setting & Participants 284 sugarcane workers in seven jobs were recruited from one company in northwestern Nicaragua. Blood and urine samples were collected before and near the end of the six-month harvest season. Predictors Job category (cane cutter, seeder, seed cutter, agrichemical applicator, irrigator, driver, factory worker); self-reported water and electrolyte solution intake. Outcomes & Measurements Change in urinary kidney injury biomarkers normalized to urine creatinine, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18), N-acetyl-β-d-glucosaminidase (NAG), and albumin; serum creatinine–based estimated glomerular filtration rate (eGFR). Results Mean eGFR was 113 mL/min/1.73 m2 and less than 5% of workers had albuminuria, field workers had increases in NGAL and IL-18 that were 1.49 (95% CI, 1.06-2.09) and 1.61 (95% CI, 1.12-2.31) times as high, respectively, as in non-field workers. Cane cutters and irrigators had the greatest increase in NGAL during the harvest, while cane cutters and seeders had the greatest increase in IL-18. Consumption of electrolyte solution was associated with lower mean NGAL and NAG among cane cutters and lower mean IL-18 and NAG among seed cutters; however, there was no overall effect of hydration among all workers. On average, workers with the largest increases in NGAL and NAG during the harvest had declines in eGFR of 4.6 (95% CI, −8.2 to −1.0) and 3.1 (95% CI, −6.7 to 0.6) mL/min/1.73 m2, respectively. Limitations Surrogate exposure measure, loss-to-follow-up. Conclusions Results are consistent with the hypothesis that occupational heat stress and volume depletion may be associated with development of kidney disease, and future studies should directly measure these occupational factors. The presence of urine tubular injury markers supports a tubulointerstitial disease that could occur with repeated tubular injury.

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Section: Discussionmentioning

confidence: 99%

Biomarkers of Kidney Injury Among Nicaraguan Sugarcane Workers

Laws

Brooks

Amador

et al. 2016

American Journal of Kidney Diseases

102

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“…Although not a recognized cause of CKD, heat stress is associated with volume depletion and may also be associated with muscle damage (rhabdomyolysis), both of which may predispose individuals to AKI, particularly in the presence of nephrotoxic medications [26,27,30,31]. Critically, there is a growing body of literature that suggests that AKI, even if mild or if the serum creatinine recovers to baseline, may result in residual structural damage and ultimately progress to clinically recognized CKD [32-36] (See Figure 1). …”

Section: Discussionmentioning

confidence: 99%

Chronic kidney disease in Nicaragua: a qualitative analysis of semi-structured interviews with physicians and pharmacists

et al. 2013

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BackgroundNorthwestern Nicaragua has a high prevalence of chronic kidney disease (CKD) of unknown cause among young adult men. In addition, frequent occurrence of urinary tract infections (UTI) among men and a dysuria syndrome described by sugarcane workers as “chistata” are both reported. This study examines health professionals´ perceptions regarding etiology of these conditions and their treatment approaches, including use of potentially nephrotoxic medications.MethodsNineteen in-person semi-structured interviews were conducted in November 2010 among ten physicians and nine pharmacists practicing in the region.ResultsHealth professionals perceived CKD as a serious and increasing problem in the region, primarily affecting young men working as manual laborers. All interviewees regarded occupational and environmental exposure to sun and heat, and dehydration as critical factors associated with the occurrence of CKD. These factors were also considered to play a role in the occurrence of chistata in the region. Health professionals indicated that reluctance among workers to hydrate might be influenced by perceptions of water contamination. Symptoms often were treated with non-steroidal anti-inflammatory drugs (NSAIDs), diuretics and antibiotics. Physicians acknowledged that the diagnosis of UTI usually was not based on microbial culture and opined that the use of potentially nephrotoxic medications may be contributing to CKD.ConclusionsInterviews provided evidence suggesting that medications such as diuretics, antibiotics and NSAIDs are widely used and sold over the counter for symptoms that may be related to dehydration and volume depletion. These factors, alone or in combination, may be possible contributors to kidney damage. Acute kidney damage coupled with volume depletion and exposures including medications and infectious agents should be further evaluated as causal factors for CKD in this region.

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“…Assuming that subclinical insults do occur and that these insults are repeated over time, what will be the chronic effect of these repeated insults on the kidney? Recently, a new paradigm has been gaining favor that AKI, even with apparent recovery in kidney function, may not be innocuous (27). In this paradigm, either repair attempts themselves or ongoing insults with subsequent repair attempts lead to a self-perpetuating cycle of inflammation and repair, resulting in kidney fibrosis and clinically recognizable CKD.…”

Section: Potential Causesmentioning

confidence: 99%

The Central American Epidemic of CKD

Weiner

McClean

Kaufman

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryRecent reports have described an apparent epidemic of CKD along the Pacific coast of Central America, such that CKD is a leading cause of death among working-age men in lower-altitude agricultural communities in this region. Given the limited availability of kidney replacement therapies in this region, CKD often is a terminal diagnosis, lending greater urgency to the identification of a modifiable cause. This article discusses the epidemiology of CKD in this region, reviews the clinical features of this CKD outbreak, discusses potential causes and the evidence supporting these hypotheses, and highlights the wider implications of this epidemic of CKD.

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Acute Kidney Injury and CKD: Chicken or Egg?

Cited by 61 publications

References 59 publications

Biomarkers of Kidney Injury Among Nicaraguan Sugarcane Workers

Biomarkers of Kidney Injury Among Nicaraguan Sugarcane Workers

Chronic kidney disease in Nicaragua: a qualitative analysis of semi-structured interviews with physicians and pharmacists

The Central American Epidemic of CKD

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