Mesoamerican nephropathy (MAN) refers to a kidney disease that primarily afflicts male labourers (usually in the agricultural sector) and has been mainly identified in regions of Central America.1 While the global prevalence and incidence is not known, in the regions where the condition has been recognised, the prevalence has been noted to be between 10% and 15%. Nearly 20 000 deaths have been attributed to this condition from El Salvador alone.2 The aetiology is unclear. It is thought to be contributed to by dehydration, malnutrition, fructose ingestion, electrolyte imbalance, pesticides, environmental toxins and heat injury. The role of genetics or other patient factors is unclear. Clusters …