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

Kidney international, 2018-03, Vol.93 (3), p.681-690 [Peer Reviewed Journal]

2017 International Society of Nephrology ;Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Mar 2018 ;ISSN: 0085-2538 ;EISSN: 1523-1755 ;DOI: 10.1016/j.kint.2017.09.012 ;PMID: 29162294

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Title:
Early detection of acute tubulointerstitial nephritis in the genesis of Mesoamerican nephropathy
Author: Fischer, Rebecca S.B. ; Vangala, Chandan ; Truong, Luan ; Mandayam, Sreedhar ; Chavarria, Denis ; Granera Llanes, Orlando M. ; Fonseca Laguna, Marcos U. ; Guerra Baez, Alvaro ; Garcia, Felix ; García-Trabanino, Ramón ; Murray, Kristy O.
Subjects: acute interstitial nephritis ; acute kidney injury ; Adult ; Agricultural Workers' Diseases - diagnosis ; Agricultural Workers' Diseases - epidemiology ; Agricultural Workers' Diseases - pathology ; Agriculture ; Analgesics ; Antibiotics ; Atrophy ; Biomarkers - blood ; Biomarkers - urine ; Biopsy ; Cell injury ; Chronic illnesses ; chronic interstitial nephritis in agricultural communities ; chronic kidney disease of unknown etiology ; Creatinine ; Diabetes ; Early Diagnosis ; Edema ; Edema - diagnosis ; Edema - epidemiology ; Edema - pathology ; Electron microscopy ; Etiology ; Fibrosis ; Fluorescent Antibody Technique ; Humans ; Hypertension ; Immunofluorescence ; Ischemia ; Kidney - pathology ; Kidney - ultrastructure ; Kidneys ; Leukocytes (neutrophilic) ; Leukocytosis ; Lymphocytes T ; Male ; Mesoamerican nephropathy ; Microscopy, Electron ; Monocytes ; Nephritis ; Nephritis, Interstitial - diagnosis ; Nephritis, Interstitial - epidemiology ; Nephritis, Interstitial - pathology ; Nephropathy ; Neutrophilia ; Neutrophils ; Nicaragua - epidemiology ; Pathology ; Patients ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Proteins ; Risk Factors ; Tubular basement membrane ; Ultrasound ; Uric acid ; Urine ; Workers ; Young Adult
Is Part Of: Kidney international, 2018-03, Vol.93 (3), p.681-690
Description: 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.
Publisher: United States: Elsevier Inc
Language: English
Identifier: ISSN: 0085-2538
EISSN: 1523-1755
DOI: 10.1016/j.kint.2017.09.012
PMID: 29162294
Source: MEDLINE
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Early detection of acute tubulointerstitial nephritis in the genesis of Mesoamerican nephropathy

2017 International Society of Nephrology ;Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Mar 2018 ;ISSN: 0085-2538 ;EISSN: 1523-1755 ;DOI: 10.1016/j.kint.2017.09.012 ;PMID: 29162294

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