Chronic Kidney Disease of Unknown Aetiology in a Seasonal Agricultural Worker: A Narrative Review of Heat Stress and Occupational Causation
DOI:
https://doi.org/10.5281/zenodo.22237593Keywords:
Chronic Kidney Disease of Unknown Aetiology, Heat Stress Nephropathy, Agricultural Workers, Occupational Health, Mesoamerican NephropathyAbstract
A young agricultural worker with declining kidney function, no diabetes, no hypertension and minimal proteinuria does not fit the
categories nephrology is organised around. The pattern has been described across three continents, it tracks occupation rather
than geography, and its likeliest cause is the work itself.
Objectives: To review the published evidence on chronic kidney disease of unknown aetiology in agricultural workers: how
prevalent it is, what distinguishes it clinically, how strong the evidence for heat stress is against the alternatives, and what this
means for a worker presenting in a receiving country.
Material and Methods: Narrative review of prospective occupational cohorts, cross-shift and cross-harvest studies, biopsy
series, intervention studies and systematic reviews indexed in PubMed and the major nephrology, occupational and
environmental health journals. No new patient data were generated; every estimate quoted is one published by the original
investigators.
Results: In a prospective cohort of 569 workers without known diabetes, hypertension or kidney disease, baseline prevalence of
chronic kidney disease was 7.4 per cent, with age-standardised prevalence highest in Salvadoran sugarcane at 14.1 per cent and
Salvadoran corn at 11.6 per cent. Among 103 Guatemalan cane harvesters, 29 per cent showed repeated severe cross-shift
creatinine fluctuations. Progression to chronic disease occurred in 8.4 per cent of 586 cane workers with acute kidney injury,
with a median eGFR change of -33.3 mL/min/1.73m2 from normal function eight months earlier.
Conclusion: The occupational pattern is consistent and the heat and workload evidence is the strongest available, with pesticide
and infectious hypotheses largely negative. Causation is not settled, and the practical implication does not depend on settling it:
the diagnosis is missed when nobody asks what the patient does for a living.
Abbreviations: AKI – Acute Kidney Injury, CKDu – Chronic Kidney Disease of Unknown Aetiology, CKDnt – Chronic Kidney
Disease of Non-Traditional Origin, eGFR – Estimated Glomerular Filtration Rate, MeN – Mesoamerican Nephropathy, WRS –
Water-Rest-Shade.
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