Environmental exposures in young adults with declining kidney function in a population at risk of Mesoamerican nephropathy

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Objectives There is an epidemic of Mesoamerican nephropathy (MeN) in Central America, where sugarcane production is prominent. Numerous causes are proposed, but to date limited evidence supports any one hypothesis. A nested case-control study using biosamples from a rural, community-based follow-up study of 350 young adults from Northwest Nicaragua at risk of MeN was conducted with the aim of characterising the associations between urinary concentrations of metals, pesticides and mycotoxins from samples collected in the first 6 months and decline in kidney function over 2 years. Methods Urine samples collected at baseline (pre-sugarcane harvest) and the first 6 month follow-up (post-sugarcane harvest) visit were tested. Twelve metals and metalloids (aluminium, total arsenic, cadmium, chromium, cobalt, copper, lead, manganese, mercury, selenium, silicon and strontium) were analysed by inductively coupled plasma-mass spectrometry. Twelve pesticides or their metabolites (2,4-dichlorophenoxyacetic acid, 3-phenoxybenzoic acid, 4-fluoro-3-phenoxybenzoic acid, chloro-3,3,3-trifluoro-1-propen-1-yl-2,2-dimethylcyclopropanecarboxylic acid, cis/trans 3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, ethylenethiourea, glyphosate, 4-chloro-2-methylphenoxy acetic acid, 3-hydroxy-pyrimetanil, 5-hydroxytiabendazole, hydroxy-tebuconazole and 3,5,6-trichloro-2-pyridinol) and two mycotoxins (ochratoxin A (OTA) and citrinin (CIT)) were analysed by liquid chromatography coupled-mass spectrometry. Differences in the creatinine-corrected urinary concentrations of the measured exposures between outcome groups (participants with stable vs declining kidney function) were examined. Results Elevated levels of aluminium and total arsenic as well as metabolites of several pesticides were detected across the population. No differences were identified between the declining and stable groups in the levels of metals or pesticides tested. OTA and CIT were below the limit of detection. Conclusions The tested metals, metalloids, pesticides and mycotoxins were not associated with loss of kidney function in participants at-risk of MeN.


  • Evangelia Theano Smpokou
  • Marvin González-Quiroz
  • Carla Martins
  • Paula Alvito
  • Jennifer Le Blond
  • Jason Glaser
  • Aurora Aragón
  • Catharina Wesseling
  • Dorothea Nitsch
  • Neil Pearce
  • Jill Norman
  • Christian H. Lindh
  • Jackie Morton
  • Ben Caplin
Enheter & grupper
Externa organisationer
  • University College London
  • University of Aveiro
  • Imperial College London
  • London School of Hygiene and Tropical Medicine
  • Karolinska Institute
  • National Autonomous University of Nicaragua
  • National Health Institute Doutor Ricardo Jorge, Lisbon
  • La Isla Network
  • Health and Safety Laboratory

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Miljömedicin och yrkesmedicin
  • Urologi och njurmedicin


Sidor (från-till)920-926
Antal sidor7
TidskriftOccupational and environmental medicine
Utgåva nummer12
StatusPublished - 2019
Peer review utfördJa