The Human Burden of Mesoamerican Nephropathy: Diagnosis and Treatment in a Complex Web of Socioeconomics, Context, and Stigma

Abstract

Mesoamerican endemic nephropathy is a form of chronic kidney disease of still undetermined cause, highly prevalent in specific areas in and around the Mesoamerican region. Generic tubulointerstitial disease is found in kidney biopsies. Incidence and mortality are high in the hot spots. Most patients continue to be diagnosed only when dialysis treatment is urgently required, even though the disease has a fairly clear, identifiable clinical presentation. MeN is a diagnosis of exclusion, identified mostly in young male individuals from affected regions during screenings, after an acute kidney injury event, or after presenting with symptoms such as cramps, numbness, tingling, weakness, dysuria, or a history of "fever." Laboratory findings include hypokalemia, hyponatremia, hyperuricemia, and altered anion gap metabolic acidosis. Several risk factors have been hypothesized, though the cause (or causes) remains elusive. Many patients remain undiagnosed because of barriers to early diagnosis and treatment, mainly the lack of awareness of the disease among the population and health care personnel, the reliance on adapted kidney function thresholds, and the limited accessibility to standard diagnostic tests at the community level. On the other hand, coverage and treatment for those diagnosed early also need improvement because some of the treatment options empirically used are not routinely available at the primary health care level and have not been adequately validated. Another relevant barrier is the stigma surrounding the disease, with communities having been suffering from high death tolls for decades without relief or an end in sight. The dissemination of knowledge—about how the disease is suspected, diagnosed, and treated—and strengthening the local primary health care services adequately will bring hope to the affected communities, enhance opportunities for early diagnosis, and open the door to secondary prevention, ultimately reducing the incidence of dialysis and mortality.