Early detection of acute tubulointerstitial nephritis in the genesis of Mesoamerican nephropathy

Rebecca S.B. Fischer, Chandan Vangala, Luan Truong, Sreedhar Mandayam, Denis Chavarria, Orlando M. Granera Llanes, Marcos U. Fonseca Laguna, Alvaro Guerra Baez, Felix Garcia, Ramón García-Trabanino, Kristy O. Murray

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

Mesoamerican nephropathy is a devastating disease of unknown etiology that affects mostly young agricultural workers in Central America. An understanding of the mechanism of injury and the early disease process is urgently needed and will aid in identification of the underlying cause and direct treatment and prevention efforts. We sought to describe the renal pathology in Mesoamerican nephropathy at its earliest clinical appearance in prospectively identified acute case patients in Nicaragua. We considered those with elevated (or increased at least 0.3 mg/dL or 1.5-fold from baseline) serum creatinine, leukocyturia, and either leukocytosis or neutrophilia for inclusion in this biopsy study. Renal tissue was obtained by ultrasound-guided biopsy for examination by light, immunofluorescence, and electron microscopy. All 11 individuals who underwent renal biopsy showed tubulointerstitial nephritis, with varying degrees of inflammation and chronicity. Interstitial cellular infiltrates (predominantly T lymphocytes and monocytes), mostly in the corticomedullary junction; neutrophilic accumulation in the tubular lumens; largely preserved glomeruli; few mild ischemic changes; and no immune deposits were noted. The acute components of tubulointerstitial nephritis were acute tubular cell injury, interstitial edema, and early fibrosis. Chronic tubulointerstitial nephritis included severe tubular atrophy, thickened tubular basement membrane, and interstitial fibrosis. Thus, renal histopathology in Mesoamerican nephropathy reveals primary interstitial disease with intact glomeruli.

Original languageEnglish (US)
Pages (from-to)681-690
Number of pages10
JournalKidney international
Volume93
Issue number3
DOIs
StatePublished - Mar 2018

Keywords

  • Mesoamerican nephropathy
  • acute interstitial nephritis
  • acute kidney injury
  • chronic interstitial nephritis in agricultural communities
  • chronic kidney disease of unknown etiology

ASJC Scopus subject areas

  • Nephrology

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