ENFERMEDAD RENAL CRÓNICA DE CAUSA NO TRADICIONAL : ARTÍCULO DE REVISIÓN

Efraín M. Castillo; Manuel Rodríguez; Ana Victoria  Jaén; Karen Courville

doi:10.48204/1608-3849.7139

Enviado abril 23, 2025

Publicado 2025-03-03

Artículos de Revisión

Vol. 37 Núm. 2 (2024): Revista médico científica

ENFERMEDAD RENAL CRÓNICA DE CAUSA NO TRADICIONAL : ARTÍCULO DE REVISIÓN

Efraín M. Castillo⁺⁻
Manuel Rodríguez⁺⁻
Ana Victoria Jaén⁺⁻
Karen Courville⁺⁻

DOI https://doi.org/10.48204/1608-3849.7139

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DOI: 10.48204/1608-3849.7139

Publicado: 2025-03-03

Derechos de autor 2025 Revista médico científica

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.

Resumen

A pesar de haber sido descrita por primera vez hace más de dos décadas, aún se desconoce la causa específica de la enfermedad renal crónica no tradicional. Se propone una etiología multifactorial que incluye el estrés térmico ocupacional, deshidratación y exposición a pesticidas y agroquímicos. A diferencia de la enfermedad renal crónica tradicional, esta no se asocia a hipertensión, diabetes, ni glomerulonefritis, y presenta poca o nula proteinuria. Para el diagnóstico se emplean criterios definidos para clasificar a los pacientes como sospechosos e iniciar el seguimiento. La enfermedad se confirma a través de una biopsia renal que muestre enfermedad temprana en ausencia de otras causas. A la fecha no se conoce un tratamiento específico, y solo las medidas preventivas han demostrado algún pronóstico favorable. En esta revisión, nuestro objetivo es resumir la información disponible sobre esta patología.

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Cockwell P, Fisher LA. The global burden of chronic kidney disease. The Lancet. [Internet]. 2020 febrero 29;395(10225):662–4. Disponible en: https://doi.org/10.1016/S0140-6736(19)32977-0.
Courville K, Bustamante N, Hurtado B, Pecchio M, Rodríguez C, Núñez-Samudio V, et al. Chronic kidney disease of nontraditional causes in central Panama. BMC Nephrol. [Internet]. 2022 agosto 5;23(1):275.
Disponible en: https://doi.org/10.1186/s12882-022-02907-3.
Velásquez IM, Castro F, Gómez B, Cuero C, Motta J. Chronic Kidney Disease in Panama: Results From the PREFREC Study and National Mortality Trends. Kidney Int Rep. [Internet]. 2017 noviembre 1;2(6):1032–41. Disponible en: https://doi.org/10.1016/j.ekir.2017.05.016.
Fernando BNTW, Alli-Shaik A, Hemage RKD, Badurdeen Z, Hettiarachchi TW, Abeysundara HTK, et al. Pilot Study of Renal Urinary Biomarkers for Diagnosis of CKD of Uncertain Etiology. Kidney Int Rep. [Internet]. 2019 octubre;4(10):1401–11.
Disponible en: https://doi.org/10.1016/j.ekir.2019.07.009.
Edirisinghe E a. NV, Manthrithilake H, Pitawala HMTGA, Dharmagunawardhane HA, Wijayawardane RL. Geochemical and isotopic evidences from groundwater and surface water for understanding of natural contamination in chronic kidney disease of unknown etiology (CKDu) endemic zones in Sri Lanka. Isotopes Environ Health Stud. [Internet]. 2018 junio;54(3):244–61. Disponible en: https://doi.org/10.1080/10256016.2017.1377704.
Gordon C, Patiño H, Valdes R. Clústers geoespaciales de altas tasas de morbi- mortalidad por enfermedad renal crónica en Panamá. [Internet]. 2018 octubre 26. Disponible en: https://doi.org/10.13140/RG.2.2.10617.93289.
Herath C. Chronic interstitial nephritis of agricultural communities: continuing with the term CKDu (chronic kidney disease of unknown cause) is detrimental. Kidney Int. [Internet]. 2020 septiembre 1;98(3):786. Disponible en: https://doi.org/10.1016/j.kint.2020.05.014.
Mendley SR, Levin A, Correa-Rotter R, Joubert B, Whelan E, Curwin B, et al. Chronic Kidney Diseases in Agricultural Communities Report from a Workshop. Kidney Int. [Internet]. 2019 noviembre;96(5):1071–6. Disponible en: https://doi.org/10.1016/j.kint.2019.06.024.
Marín Trigueros D, Guadamuz Hernandez S, Suarez Brenes G, Salas Garita F. Nefropatía Mesoamericana. Med. leg. Costa Rica [Internet]. 2020 marzo; 37 (1): 121-129. Disponible en: http://www.scielo.sa.cr/scielo.php?script=sci_arttext&pid=S1409-00152020000100121&lng=en.
Schlader ZJ, Hostler D, Parker MD, Pryor RR, Lohr JW, Johnson BD, et al. The Potential for Renal Injury Elicited by Physical Work in the Heat. Nutrients. [Internet]. 2019 septiembre 4;11(9):2087. Disponible en: https://doi.org/10.3390/nu11092087.
Fitria L, Prihartono NA, Ramdhan DH, Wahyono TYM, Kongtip P, Woskie S. Environmental and Occupational Risk Factors Associated with Chronic Kidney Disease of Unknown Etiology in West Javanese Rice Farmers, Indonesia. Int J Environ Res Public Health. [Internet]. 2020 junio;17(12):4521. Disponible: https://doi.org/10.3390/ijerph17124521.
Johnson RJ, Wesseling C, Newman LS. Chronic Kidney Disease of Unknown Cause in Agricultural Communities. N Engl J Med. [Internet]. 2019 mayo 9;380(19):1843–52. Disponible en: https://doi.org/10.1056/NEJMra1813869.
Xu S, Yi X, Liu W, Zhang C, Massey IY, Yang F, et al. A Review of Nephrotoxicity of Microcystins. Toxins. [Internet]. 2020 octubre 31;12(11):693. Disponible en: https://doi.org/10.3390/toxins12110693.
Orantes CM, Herrera R, Almaguer M, Brizuela EG, Hernández CE, Bayarre H, et al. Chronic kidney disease and associated risk factors in the Bajo Lempa region of El Salvador: Nefrolempa study, 2009. MEDICC Rev. [Internet]. 2011 octubre;13(4):14–22. Disponible en: https://doi.org/10.37757/MR2011V13.N4.5.
De Silva PMCS, Mohammed Abdul KS, Eakanayake EMDV, Jayasinghe SS, Jayasumana C, Asanthi HB, et al. Urinary Biomarkers KIM-1 and NGAL for Detection of Chronic Kidney Disease of Uncertain Etiology (CKDu) among Agricultural Communities in Sri Lanka. PLoS Negl Trop Dis. [Internet]. 2016 septiembre;10(9):e0004979. Disponible en: https://doi.org/10.1371/journal.pntd.0004979.
Nayak S, Rehman T, Patel K, Dash P, Alice A, Kanungo S, et al. Factors Associated with Chronic Kidney Disease of Unknown Etiology (CKDu): A Systematic Review. Healthcare. [Internet]. 2023 enero;11(4):551. Disponible en: https://doi.org/10.3390/healthcare11040551.
Sunil-Chandra NP, Jayaweera JAAS, Kumbukgolla W, Jayasundara MVML. Association of Hantavirus Infections and Leptospirosis With the Occurrence of Chronic Kidney Disease of Uncertain Etiology in the North Central Province of Sri Lanka: A Prospective Study With Patients and Healthy Persons. Front Cell Infect Microbiol [Internet]. 2020; 10. Disponible en: https://doi.org/10.3389/fcimb.2020.556737.
Madero M. Is an Environmental Nephrotoxin the Primary Cause of CKDu (Mesoamerican Nephropathy)? Commentary. Kidney360. [Internet]. 2020 julio;1(7):602. Disponible en: https://doi.org/10.34067/KID.0003412020.
Fischer RSB, Mandayam S, Chavarria D, Vangala C, Nolan MS, Garcia LL, et al. Clinical Evidence of Acute Mesoamerican Nephropathy. Am J Trop Med Hyg. [Internet]. 2017 octubre;97(4):1247–56. Disponible en: https://doi.org/10.4269/ajtmh.17-0260.
Dally M, Butler-Dawson J, Cruz A, Krisher L, Johnson RJ, Asensio C, et al. Longitudinal trends in renal function among first time sugarcane harvesters in Guatemala. Bolignano D, editor. PLOS ONE [Internet]. 2020 marzo 6;15(3):e0229413. Disponible en: https://doi.org/10.1371/journal.pone.0229413.
Fernando WBNT, Hettiarachchi TW, Sudeshika T, Badurdeen Z, Abeysundara H, Ranasinghe S, et al. Snap shot view on anaemia in chronic kidney disease of uncertain aetiology. Nephrology [Internet]. 2019;24(10):1033–40. Disponible en: https://doi.org/10.1111/nep.13545.
Caplin B, Yang CW, Anand S, Levin A, Madero M, Saran R, et al. The International Society of Nephrology’s International Consortium of Collaborators on Chronic Kidney Disease of Unknown Etiology: report of the working group on approaches to population-level detection strategies and recommendations for a minimum dataset. Kidney Int [Internet]. 2019 enero; 95(1):4–10. Disponible en: https://doi.org/10.1016/j.kint.2018.08.019.
Wesseling C, Aragón A, González M, Weiss I, Glaser J, Rivard CJ, et al. Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua. BMJ Open [Internet]. 2016 diciembre 1;6(12):e011034. Disponible en: https://doi.org/10.1136/bmjopen-2016-011034.
Correa-Rotter R, Wesseling C, Johnson RJ. CKD of Unknown Origin in Central America: The Case for a Mesoamerican Nephropathy. Am J Kidney Dis [Internet]. 2014 marzo; 63(3):506–20. Disponible: https://doi.org/10.1053/j.ajkd.2013.10.062.
Wijkström J, Leiva R, Elinder CG, et al. Clinical and pathological characterization of Mesoamerican nephropathy: a new kidney disease in Central America. Am J Kidney Dis [Internet]. 2013;62(5):908-918. Disponible en: https://doi.org/10.1053/j.ajkd.2013.05.019.
Stalin P, Purty AJ, Abraham G. Distribution and Determinants of Chronic Kidney Disease of Unknown Etiology: A Brief Overview. Indian J Nephrol [Internet]. 2020; 30(4):241–4. Disponible en: https://doi.org/10.4103/ijn.IJN_313_18.
Nanayakkara S, Senevirathna STMLD, Karunaratne U, Chandrajith R, Harada KH, Hitomi T, et al. Evidence of tubular damage in the very early stage of chronic kidney disease of uncertain etiology in the North Central Province of Sri Lanka: a cross-sectional study. Environ Health Prev Med [Internet]. 2012 marzo; 17(2):109–17. Disponible en: https://doi.org/10.1007/s12199-011-0224-z.
Wijetunge S, Ratnatunga NVI, Abeysekera TDJ, Wazil AWM, Selvarajah M. Endemic chronic kidney disease of unknown etiology in Sri Lanka: Correlation of pathology with clinical stages. Indian J Nephrol [Internet]. 2015; 25(5):274–80. Disponible en: https://doi.org/10.4103/0971-4065.145095.
Ferreiro, Alejandro et al. Confirmed clinical case of chronic kidney disease of nontraditional causes in agricultural communities in Central America: a case definition for surveillance. Revista Panamericana de Salud Pública [Internet]. 2016 noviembre; 40(5):301–8. Disponible en: ISSN 1680-5348.
López-Marín L, et al. Histopathology of Chronic Kidney Disease of Unknown Etiology in Salvadoran Agricultural Communities. MEDICC Rev [Internet]. 2014; 16(2):49–54. Disponible en: https://doi.org/10.37757/MR2014.V16.N2.8.
Lusco MA, Fogo AB, Wernerson AÖ, Najafian B, Alpers CE. AJKD Atlas of Renal Pathology: CKD of Unknown Cause (CKDu); Mesoamerican Nephropathy. Am J Kidney Dis Off J Natl Kidney Found [Internet]. 2017 septiembre; 70(3):e17–8. Disponible en: https://doi.org/10.1053/j.ajkd.2017.07.001.
Glaser J, Hansson E, Weiss I, Wesseling C, Jakobsson K, Ekström U, et al. Preventing kidney injury among sugarcane workers: promising evidence from enhanced workplace interventions. Occup Environ Med [Internet]. 2020 agosto 1;77(8):527–34. Disponible en: https://doi.org/10.1136/oemed-2020-106406.
Fischer RSB, Vangala C, Mandayam S, Chavarria D, García-Trabanino R, Garcia F, et al. Clinical markers to predict progression from acute to chronic kidney disease in Mesoamerican nephropathy. Kidney Int [Internet]. 2018 diciembre; 94(6):1205–16. Disponible en: https://doi.org/10.1016/j.kint.2018.08.020.
Yang X, Wu H, Li H. Dehydration-associated chronic kidney disease: a novel case of kidney failure in China. BMC Nephrol [Internet]. 2020 mayo 4;21(1):159. Disponible en: https://doi.org/10.1186/s12882-020-01804-x.
Atanda A, Henry J, Samuel G, Fadiran O, Frederick C, Omole O, et al. Hyperuricemia-associated Mesoamerican Nephropathy: Case Report and Review of Literature. Cureus [Internet]. 2018 septiembre 11. 10(9):e3282. Disponible en: https://doi.org/10.7759/cureus.3282.
Valdivia Mazeyra MF, Muñoz Ramos P, Serrano R, Alonso Riaño M, Gil Giraldo Y, Quiroga B. Mesoamerican nephropathy: A not so unknown chronic kidney disease. Nefrol Engl Ed [Internet]. 2021 noviembre 1;41(6):612–9. Disponible en: https://doi.org/10.1016/j.nefroe.2021.12.009.
Goraya N, Wesson DE. Clinical evidence that treatment of metabolic acidosis slows the progression of chronic kidney disease. Curr Opin Nephrol Hypertens [Internet]. 2019 mayo; 28(3):267–77. Disponible en: https://doi.org/10.1097/MNH.0000000000000491.

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[1] Cockwell P, Fisher LA. The global burden of chronic kidney disease. The Lancet. [Internet]. 2020 febrero 29;395(10225):662–4. Disponible en: https://doi.org/10.1016/S0140-6736(19)32977-0.

[2] Courville K, Bustamante N, Hurtado B, Pecchio M, Rodríguez C, Núñez-Samudio V, et al. Chronic kidney disease of nontraditional causes in central Panama. BMC Nephrol. [Internet]. 2022 agosto 5;23(1):275.

[3] Disponible en: https://doi.org/10.1186/s12882-022-02907-3.

[4] Velásquez IM, Castro F, Gómez B, Cuero C, Motta J. Chronic Kidney Disease in Panama: Results From the PREFREC Study and National Mortality Trends. Kidney Int Rep. [Internet]. 2017 noviembre 1;2(6):1032–41. Disponible en: https://doi.org/10.1016/j.ekir.2017.05.016.

[5] Fernando BNTW, Alli-Shaik A, Hemage RKD, Badurdeen Z, Hettiarachchi TW, Abeysundara HTK, et al. Pilot Study of Renal Urinary Biomarkers for Diagnosis of CKD of Uncertain Etiology. Kidney Int Rep. [Internet]. 2019 octubre;4(10):1401–11.

[6] Disponible en: https://doi.org/10.1016/j.ekir.2019.07.009.

[7] Edirisinghe E a. NV, Manthrithilake H, Pitawala HMTGA, Dharmagunawardhane HA, Wijayawardane RL. Geochemical and isotopic evidences from groundwater and surface water for understanding of natural contamination in chronic kidney disease of unknown etiology (CKDu) endemic zones in Sri Lanka. Isotopes Environ Health Stud. [Internet]. 2018 junio;54(3):244–61. Disponible en: https://doi.org/10.1080/10256016.2017.1377704.

[8] Gordon C, Patiño H, Valdes R. Clústers geoespaciales de altas tasas de morbi- mortalidad por enfermedad renal crónica en Panamá. [Internet]. 2018 octubre 26. Disponible en: https://doi.org/10.13140/RG.2.2.10617.93289.

[9] Herath C. Chronic interstitial nephritis of agricultural communities: continuing with the term CKDu (chronic kidney disease of unknown cause) is detrimental. Kidney Int. [Internet]. 2020 septiembre 1;98(3):786. Disponible en: https://doi.org/10.1016/j.kint.2020.05.014.

[10] Mendley SR, Levin A, Correa-Rotter R, Joubert B, Whelan E, Curwin B, et al. Chronic Kidney Diseases in Agricultural Communities Report from a Workshop. Kidney Int. [Internet]. 2019 noviembre;96(5):1071–6. Disponible en: https://doi.org/10.1016/j.kint.2019.06.024.

[11] Marín Trigueros D, Guadamuz Hernandez S, Suarez Brenes G, Salas Garita F. Nefropatía Mesoamericana. Med. leg. Costa Rica [Internet]. 2020 marzo; 37 (1): 121-129. Disponible en: http://www.scielo.sa.cr/scielo.php?script=sci_arttext&pid=S1409-00152020000100121&lng=en.

[12] Schlader ZJ, Hostler D, Parker MD, Pryor RR, Lohr JW, Johnson BD, et al. The Potential for Renal Injury Elicited by Physical Work in the Heat. Nutrients. [Internet]. 2019 septiembre 4;11(9):2087. Disponible en: https://doi.org/10.3390/nu11092087.

[13] Fitria L, Prihartono NA, Ramdhan DH, Wahyono TYM, Kongtip P, Woskie S. Environmental and Occupational Risk Factors Associated with Chronic Kidney Disease of Unknown Etiology in West Javanese Rice Farmers, Indonesia. Int J Environ Res Public Health. [Internet]. 2020 junio;17(12):4521. Disponible: https://doi.org/10.3390/ijerph17124521.

[14] Johnson RJ, Wesseling C, Newman LS. Chronic Kidney Disease of Unknown Cause in Agricultural Communities. N Engl J Med. [Internet]. 2019 mayo 9;380(19):1843–52. Disponible en: https://doi.org/10.1056/NEJMra1813869.

[15] Xu S, Yi X, Liu W, Zhang C, Massey IY, Yang F, et al. A Review of Nephrotoxicity of Microcystins. Toxins. [Internet]. 2020 octubre 31;12(11):693. Disponible en: https://doi.org/10.3390/toxins12110693.

[16] Orantes CM, Herrera R, Almaguer M, Brizuela EG, Hernández CE, Bayarre H, et al. Chronic kidney disease and associated risk factors in the Bajo Lempa region of El Salvador: Nefrolempa study, 2009. MEDICC Rev. [Internet]. 2011 octubre;13(4):14–22. Disponible en: https://doi.org/10.37757/MR2011V13.N4.5.

[17] De Silva PMCS, Mohammed Abdul KS, Eakanayake EMDV, Jayasinghe SS, Jayasumana C, Asanthi HB, et al. Urinary Biomarkers KIM-1 and NGAL for Detection of Chronic Kidney Disease of Uncertain Etiology (CKDu) among Agricultural Communities in Sri Lanka. PLoS Negl Trop Dis. [Internet]. 2016 septiembre;10(9):e0004979. Disponible en: https://doi.org/10.1371/journal.pntd.0004979.

[18] Nayak S, Rehman T, Patel K, Dash P, Alice A, Kanungo S, et al. Factors Associated with Chronic Kidney Disease of Unknown Etiology (CKDu): A Systematic Review. Healthcare. [Internet]. 2023 enero;11(4):551. Disponible en: https://doi.org/10.3390/healthcare11040551.

[19] Sunil-Chandra NP, Jayaweera JAAS, Kumbukgolla W, Jayasundara MVML. Association of Hantavirus Infections and Leptospirosis With the Occurrence of Chronic Kidney Disease of Uncertain Etiology in the North Central Province of Sri Lanka: A Prospective Study With Patients and Healthy Persons. Front Cell Infect Microbiol [Internet]. 2020; 10. Disponible en: https://doi.org/10.3389/fcimb.2020.556737.

[20] Madero M. Is an Environmental Nephrotoxin the Primary Cause of CKDu (Mesoamerican Nephropathy)? Commentary. Kidney360. [Internet]. 2020 julio;1(7):602. Disponible en: https://doi.org/10.34067/KID.0003412020.

[21] Fischer RSB, Mandayam S, Chavarria D, Vangala C, Nolan MS, Garcia LL, et al. Clinical Evidence of Acute Mesoamerican Nephropathy. Am J Trop Med Hyg. [Internet]. 2017 octubre;97(4):1247–56. Disponible en: https://doi.org/10.4269/ajtmh.17-0260.

[22] Dally M, Butler-Dawson J, Cruz A, Krisher L, Johnson RJ, Asensio C, et al. Longitudinal trends in renal function among first time sugarcane harvesters in Guatemala. Bolignano D, editor. PLOS ONE [Internet]. 2020 marzo 6;15(3):e0229413. Disponible en: https://doi.org/10.1371/journal.pone.0229413.

[23] Fernando WBNT, Hettiarachchi TW, Sudeshika T, Badurdeen Z, Abeysundara H, Ranasinghe S, et al. Snap shot view on anaemia in chronic kidney disease of uncertain aetiology. Nephrology [Internet]. 2019;24(10):1033–40. Disponible en: https://doi.org/10.1111/nep.13545.

[24] Caplin B, Yang CW, Anand S, Levin A, Madero M, Saran R, et al. The International Society of Nephrology’s International Consortium of Collaborators on Chronic Kidney Disease of Unknown Etiology: report of the working group on approaches to population-level detection strategies and recommendations for a minimum dataset. Kidney Int [Internet]. 2019 enero; 95(1):4–10. Disponible en: https://doi.org/10.1016/j.kint.2018.08.019.

[25] Wesseling C, Aragón A, González M, Weiss I, Glaser J, Rivard CJ, et al. Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua. BMJ Open [Internet]. 2016 diciembre 1;6(12):e011034. Disponible en: https://doi.org/10.1136/bmjopen-2016-011034.

[26] Correa-Rotter R, Wesseling C, Johnson RJ. CKD of Unknown Origin in Central America: The Case for a Mesoamerican Nephropathy. Am J Kidney Dis [Internet]. 2014 marzo; 63(3):506–20. Disponible: https://doi.org/10.1053/j.ajkd.2013.10.062.

[27] Wijkström J, Leiva R, Elinder CG, et al. Clinical and pathological characterization of Mesoamerican nephropathy: a new kidney disease in Central America. Am J Kidney Dis [Internet]. 2013;62(5):908-918. Disponible en: https://doi.org/10.1053/j.ajkd.2013.05.019.

[28] Stalin P, Purty AJ, Abraham G. Distribution and Determinants of Chronic Kidney Disease of Unknown Etiology: A Brief Overview. Indian J Nephrol [Internet]. 2020; 30(4):241–4. Disponible en: https://doi.org/10.4103/ijn.IJN_313_18.

[29] Nanayakkara S, Senevirathna STMLD, Karunaratne U, Chandrajith R, Harada KH, Hitomi T, et al. Evidence of tubular damage in the very early stage of chronic kidney disease of uncertain etiology in the North Central Province of Sri Lanka: a cross-sectional study. Environ Health Prev Med [Internet]. 2012 marzo; 17(2):109–17. Disponible en: https://doi.org/10.1007/s12199-011-0224-z.

[30] Wijetunge S, Ratnatunga NVI, Abeysekera TDJ, Wazil AWM, Selvarajah M. Endemic chronic kidney disease of unknown etiology in Sri Lanka: Correlation of pathology with clinical stages. Indian J Nephrol [Internet]. 2015; 25(5):274–80. Disponible en: https://doi.org/10.4103/0971-4065.145095.

[31] Ferreiro, Alejandro et al. Confirmed clinical case of chronic kidney disease of nontraditional causes in agricultural communities in Central America: a case definition for surveillance. Revista Panamericana de Salud Pública [Internet]. 2016 noviembre; 40(5):301–8. Disponible en: ISSN 1680-5348.

[32] López-Marín L, et al. Histopathology of Chronic Kidney Disease of Unknown Etiology in Salvadoran Agricultural Communities. MEDICC Rev [Internet]. 2014; 16(2):49–54. Disponible en: https://doi.org/10.37757/MR2014.V16.N2.8.

[33] Lusco MA, Fogo AB, Wernerson AÖ, Najafian B, Alpers CE. AJKD Atlas of Renal Pathology: CKD of Unknown Cause (CKDu); Mesoamerican Nephropathy. Am J Kidney Dis Off J Natl Kidney Found [Internet]. 2017 septiembre; 70(3):e17–8. Disponible en: https://doi.org/10.1053/j.ajkd.2017.07.001.

[34] Glaser J, Hansson E, Weiss I, Wesseling C, Jakobsson K, Ekström U, et al. Preventing kidney injury among sugarcane workers: promising evidence from enhanced workplace interventions. Occup Environ Med [Internet]. 2020 agosto 1;77(8):527–34. Disponible en: https://doi.org/10.1136/oemed-2020-106406.

[35] Fischer RSB, Vangala C, Mandayam S, Chavarria D, García-Trabanino R, Garcia F, et al. Clinical markers to predict progression from acute to chronic kidney disease in Mesoamerican nephropathy. Kidney Int [Internet]. 2018 diciembre; 94(6):1205–16. Disponible en: https://doi.org/10.1016/j.kint.2018.08.020.

[36] Yang X, Wu H, Li H. Dehydration-associated chronic kidney disease: a novel case of kidney failure in China. BMC Nephrol [Internet]. 2020 mayo 4;21(1):159. Disponible en: https://doi.org/10.1186/s12882-020-01804-x.

[37] Atanda A, Henry J, Samuel G, Fadiran O, Frederick C, Omole O, et al. Hyperuricemia-associated Mesoamerican Nephropathy: Case Report and Review of Literature. Cureus [Internet]. 2018 septiembre 11. 10(9):e3282. Disponible en: https://doi.org/10.7759/cureus.3282.

[38] Valdivia Mazeyra MF, Muñoz Ramos P, Serrano R, Alonso Riaño M, Gil Giraldo Y, Quiroga B. Mesoamerican nephropathy: A not so unknown chronic kidney disease. Nefrol Engl Ed [Internet]. 2021 noviembre 1;41(6):612–9. Disponible en: https://doi.org/10.1016/j.nefroe.2021.12.009.

[39] Goraya N, Wesson DE. Clinical evidence that treatment of metabolic acidosis slows the progression of chronic kidney disease. Curr Opin Nephrol Hypertens [Internet]. 2019 mayo; 28(3):267–77. Disponible en: https://doi.org/10.1097/MNH.0000000000000491.

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