Elsevier

The Lancet

Volume 383, Issue 9931, 24–30 May 2014, Pages 1794-1795
The Lancet

World Report
Kidney disease in farming communities remains a mystery

https://doi.org/10.1016/S0140-6736(14)60867-9Get rights and content

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Reports of disease

Vivekanand Jha, executive director of the George Institute for Global Health India, and professor of nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, has noted reports of cases of unexplained advanced kidney failure over the past 8–10 years in Central America, rural areas of the central districts of Sri Lanka, and India (coastal regions of the eastern states Andhra Pradesh and Odisha). Similar cases have also been reported in the Balkans, along the river

Possible causes

Most people with the kidney disease are men, aged 20–40 years, who are agricultural, farm, or sugarcane workers, notes Jha. The disease progresses slowly and is mostly asymptomatic, but patients can end up needing dialysis or kidney transplantation. Other common factors are poverty, hot and humid environments, insufficient access to health care, and suboptimum water quality and sanitation. Jha believes some people might also have a genetic susceptibility.

Causes that have been postulated, but

Ecosystem health approach

“None of the biological and environmental causes are in a vacuum, but exist in a socioeconomic and political context that allows them to induce kidney damage”, stresses Wesseling. The Mesoamerican nephropathy epidemic, she proposes, should be addressed with an ecosystem health approach, which integrates occupational and environmental health, social, and economic aspects at micro and macro levels in the identification of the causes and in the design of solutions.

She also stresses the importance

Prevention and treatment

In western countries, the numbers of cases of chronic kidney disease of unknown cause are low compared with the number in India. However, Sanjay Kumar Agarwal, professor of nephrology, All India Institute of Medical Sciences, New Delhi, India, is not convinced there is a real increase in the number of cases in India. He believes that a thorough assessment of the patients might have led to a precise diagnosis—such as chronic glomerulonephritis or tubulointerstitial disease—rather than chronic

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