Central American Institute for Studies on Toxic Substances (IRET-UNA) Program on Work, Environment and Health in Central America (SALTRA) Serie SALUD, TRABAJO Y International Research Workshop on MeN Workshop Research International AMBIENTE 33 Second 1 Report from the from Report MESOAMERICAN NEPHROPATHY Report from the Second International Research Workshop on MeN MESOAMERICAN NEPHROPATHY MESOAMERICAN Programa Financiado por la Unión Europea MESOAMERICAN NEPHROPATHY Report from the Second International Research Workshop on MeN 616.61 I-61m International Workshop on Mesoamerican Nephropathy (2°: 2015 nov. 18-20 : San José, Costa Rica) Mesoamerican nephropathy: report from the second international research workshop on men / David Wegman …[et. al.]. -- 1 ed. – Heredia, C.R.: SALTRA / IRET- UNA, 2016. 200 p.: il.; 21.5 x 25.5 cm. -- (Serie Salud; Trabajo y Ambiente; n° 33). Publicado también con la serie: Informe técnicos IRET, n° 34 ISBN 978-9968-924-33-7 1. RIÑONES. 2. ENFERMEDADES 3. NEFROLOGIA. 4. EPIDEMIOLOGIA 5. ENFERMEDADES OCUPACIONALES 6. ENFERMEDADES DEL APARATO URINARIO 7. ESTRÉS 8. HOMBRES 9. AGRICULTURA 10.MESOAMÉRICA I. Wegman, David… [et. al.]. II. Título. III. SALTRA. IV. IRET- UNA. Program on Work, Environment and Health in Central America (SALTRA) (+)506-2263-6375 www.saltra.una.ac.cr Central American Institute for Studies on Toxic Substances (IRET) (+)506-2277-3584 www.una.ac.cr/iret EDITORS: David Wegman Jennifer Crowe Christer Hogstedt Kristina Jakobsson Catharina Wesseling © SALTRA SALTRA and the editors of this report invite you to reproduce and otherwise use the material in this report to inform research, healthcare, prevention and policy efforts to lessen the effects of chronic kidney disease of unknown origin. There is no charge and you do not need permission. However, we ask that you please cite both the report as well as the individual authors of any part of the report you use. CORRESPONDENCE TO: Jennifer Crowe IRET-SALTRA-UNA Email: [email protected] (+) 506-2277-3584 This publication has been created with assistance from the European Union. Its content is the exclusive responsibility of the SALTRA program and in no case should be considered to reflect the views of the European Union. En colaboración con el Programa de Publicaciones e impresiones de la Universidad Nacional, Costa Rica. MESOAMERICAN NEPHROPATHY Report from the Second International Research Workshop on MeN Bringing together knowledge, research questions, and initiatives related to Chronic Kidney Disease of unknown origin in Mesoamerica NOVEMBER 18-20, 2015 HOTEL AUROLA HOLIDAY INN, SAN JOSÉ, COSTA RICA Organized by Central American Program for Work, Editors: Environment and Health – SALTRA Central American Institute for David Wegman Studies on Toxic Substances (IRET) Universidad Nacional (UNA), Jennifer Crowe Costa Rica. Christer Hogstedt Kristina Jakobsson Technical Series SALTRA Catharina Wesseling Program for Work, Environment and Health in Central America (SALTRA) (+506) 2263-6375 / www.salta.una.ac.cr MAIN MESSAGE different research groups in several countries that Mesoamerican NephropathyThere is general has a scientific predominantly consensus occupational based on multiplecomponent. studies There by is growing evidence for a causal role of strenuous work, heat and been made towards clarifying pathophysiological pathways for heatinsufficient stress leadingrehydration to chronic as risk kidney factors disease. in MeN, Intervention and progress studies has are warranted to reduce heat stress and dehydration in high risk workers. It is also quite possible that other factors also play a role in the disease, perhaps in combination with heat stress and dehydration. need further evaluation as possible risk factors related to disease initiationExposures or to progression. specific agrochemicals The roles ofor infectiousother yet-unknown agents, NSAIDs, toxins genetic susceptibility, gene-environment interactions and social determinants as contributors to disease onset and progression also Social and economic drivers of the disease, including working conditions,need to be clarified. unemployment and precarious employment and poverty in general need to be analyzed both in community and workplace studies. There is a need for standardized studies (including simple prevalence studies) to enable valid comparisons between countries and regions. This is an important step in ascertaining whether the epidemic of CKDu in Central America that we have called MeN is pathophysiologically similar to what is occurring in other parts of the world. Coordinated regional approaches to study prevalence, causes of this disease and to seek viable solutions the challenges itetiology, presents. and to evaluate interventions are needed to find the Declaración de la Junta del CENCAM y el Comité Científico del 2do Taller Internacional sobre Nefropatía Mesoamericana referente a los hechos actualmente conocidos sobre la epidemia l 2do Taller Internacional sobre la Epide- mia de Nefropatía Mesoamericana (MeN, Statement of the CENCAM Board E por su nombre en inglés) fue celebrado and the Scientific Committee of the en San José, Costa Rica, del 18 al 20 de noviem- 2nd International Workshop on bre del 2015, tres años después de realizar el Mesoamerican Nephropathy regarding primer taller. Un total de 75 expertos de 18 paí- currently known facts about the ses discutieron la evidencia sobre las posibles - epidemic cas, y las similitudes y diferencias con otras epi- demiascausas dede laenfermedad MeN, sus secuenciasrenal crónica fisiopatológi no relacio- he 2nd International Workshop on the nada con las causas de tradicionales de diabetes Epidemic of Mesoamerican Nephropa- e hipertensión (ERCu) en Sri Lanka y otras par- T thy (MeN) was held in San José, Costa tes del mundo. La discusión también incluyó los Rica, November 18-20, 2015, three years after métodos para evaluar diferentes aspectos de la epidemia, que abarcaron desde preguntas sobre 18 countries discussed the evidence regard- su etiología hasta las intervenciones dirigidas a ingthe firstpossible workshop. causes Aof total MeN, of pathophysiologic75 experts from su prevención. Actualmente estamos preparan- pathways, and similarities and differences with do un informe técnico completo, pero conside- other epidemics of chronic kidney disease un- rando la urgencia de tomar medidas para hacer related to traditional CKD causes of diabetes - and hypertension (CKDu) in Sri Lanka and oth- vulgar esta declaración inicial con algunas de las er parts of the world. The discussion also ad- conclusionesfrente a esta enfermedadclaves sobre mortal,la MeN. se justifica di dressed methods to assess different aspects of Hubo consenso en que la Nefropatía Mesoa- the epidemic, ranging from etiologic questions mericana tiene un componente predominante- to interventions aimed at prevention. A compre- mente ocupacional. Dicha conclusión se basa en hensive technical report is in preparation, but los múltiples estudios con variedad de diseños an interim statement of some key conclusions realizados por múltiples grupos de investigación y en diferentes países. Hay evidencia creciente of taking action to address this fatal disease. sobre el papel causal del trabajo extenuante, el aboutThere MeN was is ajustified consensus considering that MeN the hasurgency pre- - dominantly an occupational component. This res de riesgo en la MeN; y se ha progresado en conclusion is based on multiple studies with calor y la rehidratación insuficiente como facto various designs by different research groups estrés por calor que conduce a la enfermedad in several countries. There is growing evidence la clarificación de las vías fisiopatológicas del- for a causal role of strenuous work, heat and tudios de intervención para reducir el estrés por calorrenal ycrónica. la deshidratación Por ende, seen justificatrabajadores realizar de alto es and progress has been made towards clarify- riesgo y, de hecho, ya se inició un importante es- insufficient rehydration as risk factors in MeN, ing pathophysiological pathways for heat stress tudio al respecto. Sin embargo, se considera que leading to chronic kidney disease. Intervention hay otros factores que también pueden jugar un studies to reduce heat stress and dehydration in papel importante, posiblemente en combina- high risk workers are warranted, and one ma- ción con el estrés por calor y la deshidratación. jor study has been initiated. However, it is quite - possible that other factors also play a role, per- cos o a otros agentes tóxicos aún desconocidos haps in combination with heat stress and dehy- requierenLa exposición ser evaluadosa algunos comoagroquímicos posibles específifactores de riesgo relacionados con el origen o la evolu- other yet-unknown toxins need further evalu- ción de la enfermedad. Con base en los estudios ationdration. as Exposurespossible risk to factorsspecific related agrochemicals to disease or realizados a la fecha, no existe evidencia sobre initiation or progression. Based on studies con- la exposición a metales pesados o alcohol como ducted to date, no evidence exists for exposure factor único o como factores de riesgo impor- to heavy metals or alcohol as sole or important risk factors for MeN. The roles of infectious el papel de los agentes infecciosos, los anti-in- agents, NSAIDs, genetic susceptibility, gene-en- tantes para la MeN. Además, se debe clarificar- vironment interactions and social determinants bilidad genética, las interacciones genético-am- as contributors to disease