Urine biomarkers of kidney injury among adolescents in Nicaragua, a region affected by an epidemic of chronic kidney disease of unknown aetiology

Oriana Ramírez-Rubio, Juan José Amador, James S. Kaufman, Daniel E. Weiner, Chirag Parikh, Usman Khan, Michael D. Mcclean, Rebecca L. Laws, Damaris López-Pilarte, David J. Friedman, Joseph Kupferman, Daniel R. Brooks

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)424-432
Number of pages9
JournalNephrology Dialysis Transplantation
Volume31
Issue number3
DOIs
StatePublished - Mar 1 2016

Fingerprint

Nicaragua
Chronic Renal Insufficiency
Biomarkers
Urine
Kidney
Wounds and Injuries
Hexosaminidases
Linear Models
Central America
Health Priorities
Geographic Locations
Interleukin-18
Urination
Environmental Exposure
Proxy
Occupational Exposure
Albumins
Creatinine
Industry
Reference Values

Keywords

  • adolescents
  • chronic kidney disease
  • Mesoamerican Nephropathy
  • Nicaragua
  • urine biomarkers

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Urine biomarkers of kidney injury among adolescents in Nicaragua, a region affected by an epidemic of chronic kidney disease of unknown aetiology. / Ramírez-Rubio, Oriana; Amador, Juan José; Kaufman, James S.; Weiner, Daniel E.; Parikh, Chirag; Khan, Usman; Mcclean, Michael D.; Laws, Rebecca L.; López-Pilarte, Damaris; Friedman, David J.; Kupferman, Joseph; Brooks, Daniel R.

In: Nephrology Dialysis Transplantation, Vol. 31, No. 3, 01.03.2016, p. 424-432.

Research output: Contribution to journalArticle

Ramírez-Rubio, O, Amador, JJ, Kaufman, JS, Weiner, DE, Parikh, C, Khan, U, Mcclean, MD, Laws, RL, López-Pilarte, D, Friedman, DJ, Kupferman, J & Brooks, DR 2016, 'Urine biomarkers of kidney injury among adolescents in Nicaragua, a region affected by an epidemic of chronic kidney disease of unknown aetiology', Nephrology Dialysis Transplantation, vol. 31, no. 3, pp. 424-432. https://doi.org/10.1093/ndt/gfv292
Ramírez-Rubio, Oriana ; Amador, Juan José ; Kaufman, James S. ; Weiner, Daniel E. ; Parikh, Chirag ; Khan, Usman ; Mcclean, Michael D. ; Laws, Rebecca L. ; López-Pilarte, Damaris ; Friedman, David J. ; Kupferman, Joseph ; Brooks, Daniel R. / Urine biomarkers of kidney injury among adolescents in Nicaragua, a region affected by an epidemic of chronic kidney disease of unknown aetiology. In: Nephrology Dialysis Transplantation. 2016 ; Vol. 31, No. 3. pp. 424-432.
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abstract = "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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AU - Ramírez-Rubio, Oriana

AU - Amador, Juan José

AU - Kaufman, James S.

AU - Weiner, Daniel E.

AU - Parikh, Chirag

AU - Khan, Usman

AU - Mcclean, Michael D.

AU - Laws, Rebecca L.

AU - López-Pilarte, Damaris

AU - Friedman, David J.

AU - Kupferman, Joseph

AU - Brooks, Daniel R.

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N2 - 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.

AB - 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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