Background

Mesoamerican Nephropathy (MeN), a form of chronic kidney disease of uncertain etiology, is a leading cause of death in Central America. The disease often presents in young adult male agricultural workers and progresses rapidly. Given the young age at presentation, we hypothesized that children in Central America experience subclinical kidney injury prior to working life.

Methods

We assessed specimens from a cross-sectional study of youth, aged 7–17 years, predominantly residing in a high-risk region of Nicaragua (n = 210). We evaluated urinary concentrations and risk factors for kidney injury biomarkers neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18), monocyte chemoattractant protein 1 (MCP-1), and chitinase-3-like protein 1 (YKL-40). We evaluated the association between biomarkers and contemporaneous eGFR and compared biomarker concentrations with reference values from healthy children in other countries.

Results

Median uNGAL, uIL-18, and uKIM-1 concentrations exceeded healthy reference values. A one-year increase in age was associated with 40% increase in odds of being in the highest quartile of uNGAL (OR 1.4; (95%CI 1.2, 1.5); p < 0.0001). Youth who reported ever experiencing dysuria had 2.5 times the odds of having uNGAL concentrations in the top quartile (OR 2.5; (95%CI 1.4, 4.6); p = 0.003). Girls had significantly higher concentrations of all biomarkers than boys. Nine percent of children demonstrated low eGFR (≤ 100 ml/min/1.73 m²), while 29% showed evidence of hyperfiltration (eGFR ≥ 160 ml/min/1.73 m²), both potentially indicative of renal dysfunction.

Conclusions

Children residing in regions of Nicaragua at high risk for MeN may experience subclinical kidney injury prior to occupational exposures.

中文翻译：

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病因不明的慢性肾脏病高危地区儿童肾损伤的生物标志物。

背景

中美洲肾病 (MeN) 是一种病因不明的慢性肾病，是中美洲的主要死亡原因。该病常发生于年轻的成年男性农业工人，并且进展迅速。鉴于就诊时年龄小，我们假设中美洲的儿童在工作前经历过亚临床肾损伤。

方法

我们评估了来自 7-17 岁青年的横断面研究的标本，这些青年主要居住在尼加拉瓜的高风险地区 ( n  = 210)。我们评估了肾损伤生物标志物中性粒细胞明胶酶相关脂质运载蛋白 (NGAL)、肾损伤分子 1 (KIM-1)、白细胞介素 18 (IL-18)、单核细胞趋化蛋白 1 (MCP-1)、和几丁质酶 3 样蛋白 1 (YKL-40)。我们评估了生物标志物与同期 eGFR 之间的关联，并将生物标志物浓度与其他国家健康儿童的参考值进行了比较。

结果

中值 uNGAL、uIL-18 和 uKIM-1 浓度超过健康参考值。年龄增加一年与 uNGAL 最高四分位数的几率增加 40% 相关（OR 1.4；（95%CI 1.2, 1.5）；p  < 0.0001）。报告曾经历过排尿困难的青年人的 uNGAL 浓度处于前四分位数的几率是其 2.5 倍（OR 2.5；（95%CI 1.4, 4.6）；p  = 0.003）。女孩的所有生物标志物浓度明显高于男孩。9% 的儿童表现出低 eGFR（≤ 100 ml/min/1.73 m ²），而 29% 表现出超滤的证据（eGFR ≥ 160 ml/min/1.73 m ²），这两者都可能表明肾功能不全。

结论

居住在尼加拉瓜高风险地区的儿童可能在职业暴露之前经历亚临床肾损伤。