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Urine biomarkers of kidney injury among adolescents in Nicaragua, a region
affected by an epidemic of chronic kidney disease of unknown aetiology
#MMPMID26311057
Ramírez-Rubio O
; Amador JJ
; Kaufman JS
; Weiner DE
; Parikh CR
; Khan U
; McClean MD
; Laws RL
; López-Pilarte D
; Friedman DJ
; Kupferman J
; Brooks DR
Nephrol Dial Transplant
2016[Mar]; 31
(3
): 424-32
PMID26311057
show ga
BACKGROUND: An epidemic of chronic kidney disease (CKD) of non-traditional
aetiology has been recently recognized by health authorities as a public health
priority in Central America. Previous studies have identified strenuous manual
work, agricultural activities and residence at low altitude as potential risk
factors; however, the aetiology remains unknown. Because individuals are
frequently diagnosed with CKD in early adulthood, we measured biomarkers of
kidney injury among adolescents in different regions of Nicaragua to assess
whether kidney damage might be initiated during childhood. METHODS: Participants
include 200 adolescents aged 12-18 years with no prior work history from four
different schools in Nicaragua. The location of the school served as a proxy for
environmental exposures and geographic locations were selected to represent a
range of factors that have been associated with CKD in adults (e.g. altitude,
primary industry and CKD mortality rates). Questionnaires, urine dipsticks and
kidney injury biomarkers [interleukin-18, N-acetyl-d-glucosaminidase (NAG),
neutrophil gelatinase-associated lipocalin (NGAL) and albumin-creatinine ratio]
were assessed. Biomarker concentrations were compared by school using linear
regression models. RESULTS: Protein (3.5%) and glucose (1%) in urine measured by
dipstick were rare and did not differ by school. Urine biomarkers of tubular
kidney damage, particularly NGAL and NAG, showed higher concentrations in those
schools and regions within Nicaragua that were defined a priori as having
increased CKD risk. Painful urination was a frequent self-reported symptom.
CONCLUSIONS: Although interpretation of these urine biomarkers is limited because
of the lack of population reference values, results suggest the possibility of
early kidney damage prior to occupational exposures in these adolescents.
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