Article By Frank Bergman
A mysterious kidney disease that has devastated young and middle-aged workers across Central America and South Asia now appears to have surfaced in Texas, where otherwise healthy men in their 20s and 30s are reportedly arriving at hospitals with life-threatening kidney failure.
The condition, known as chronic kidney disease of unknown etiology (CKDu) or Mesoamerican nephropathy, has baffled researchers because victims can suffer severe kidney damage despite lacking the traditional risk factors for the disease.
Unlike conventional chronic kidney disease, patients do not necessarily have diabetes, high blood pressure, or glomerulonephritis.
Instead, the mysterious illness has disproportionately struck agricultural and manual laborers working in extreme heat.
“It typically strikes young to middle-aged adults, more often men, who work in agriculture and manual labor in hot, low-resource regions,” warned Dr. Gokul Paidi, a family medicine physician at Community Healthcare Network in New York.
Now, doctors are seeing disturbing signs of the same phenomenon in Texas.
Young Men Arriving at Texas Hospitals with Kidney Failure
Physicians at Houston safety-net hospitals, including Ben Taub, have treated otherwise healthy men in their 20s and 30s suffering from kidney failure, with some reportedly arriving with “Coca-Cola-colored urine.”
The patients reportedly lack the usual conditions that would explain such serious kidney damage.
“What’s striking about the Texas cases is how closely they mirror what we saw originally in Central America,” Paidi said.
Many of the patients are illegal alien laborers from Mexico and Central America who work in construction, roofing, and other outdoor trades under extreme heat conditions, where access to water breaks can be limited.
A review of Harris County hospital records found that roughly one in six emergency dialysis cases involving uninsured or illegal alien patients had no identifiable cause.
Paidi said the finding is “consistent with CKDu.”
Tracking the emerging disease has also become difficult because some patients are reportedly reluctant to seek medical care or participate in research due to concerns surrounding their immigration status.
That means kidney damage can continue undetected until it becomes irreversible.
Mysterious Disease Has Spread Across the World
Mesoamerican nephropathy was first identified among sugarcane workers in El Salvador and Nicaragua in the late 1990s.
Similar localized kidney disease epidemics have since been identified in Sri Lanka, India, rural Thailand, and Mexico’s Tierra Blanca region.
Other regional kidney diseases have also emerged over the decades, although researchers do not classify all of them as CKDu.
“Balkan endemic nephropathy has been documented since the 1950s, Itai itai disease in Japan was tied to cadmium-contaminated rice, and Sri Lanka nephropathy has been studied since the 1990s,” Paidi said.
Researchers increasingly suspect the outbreaks could represent variations of the same underlying disease process.
“What’s emerging is that these are likely related conditions, essentially clusters of the same underlying disease process showing up in different farming and industrial regions around the world,” Paidi said.
Disease Can Remain Hidden Until Kidneys Are Failing
One of the most dangerous features of CKDu is that victims may initially have no idea anything is wrong.
Experts describe it as a “silent disease” because symptoms often do not emerge until substantial kidney damage has already occurred.
Dr. Richard J. Johnson, an expert on kidney disease and emeritus professor of medicine at the University of Colorado, said many sugarcane workers discover the condition only through routine blood testing.
“Later, it can cause typical signs of severe chronic kidney disease, including fatigue, sleep disturbances, nausea, weakness [and] shortness of breath from anemia,” Johnson said.
By that stage, patients can already be approaching end-stage kidney disease.
The consequences can be particularly deadly in poorer regions where dialysis and kidney transplantation are inaccessible or prohibitively expensive.
“Disease often progresses rapidly over a few years, and dialysis and transplantation are rarely available, so mortality is high,” Johnson warned.
Cause Remains Unknown
Researchers still do not know exactly what is causing the disease.
Heat stress is considered one of the leading suspects, with experts investigating whether years of strenuous physical labor, repeated dehydration, and environmental exposures gradually destroy kidney function.
Agricultural workers can also face exposure to pesticides and smoke from burning sugarcane.
Other possible contributing factors include unsafe drinking water and frequent use of over-the-counter nonsteroidal anti-inflammatory drugs, or NSAIDs, to cope with pain.
Combined with extreme heat and repeated dehydration, those factors could place additional strain on the kidneys.
Experts have suggested that more shade, better hydration, reduced working hours, and beginning shifts earlier in the day could potentially reduce kidney damage.
No Specific Test or Cure
There is currently no single diagnostic test that can confirm CKDu.
Doctors instead diagnose the condition by eliminating other known causes of chronic kidney disease while examining a patient’s occupation and environmental exposure.
“Kidney biopsy is the closest thing to a gold standard, but isn’t practical for widespread screening,” Paidi said.
There is also no disease-specific treatment.
Doctors can attempt to control blood pressure, prevent additional kidney injury, and warn patients against medications that could further damage the organs.
Advanced cases ultimately require dialysis or transplantation.
Some patients are prescribed ACE inhibitors, but Johnson cautioned that the medications can sometimes worsen kidney function when patients are dehydrated.
With a mysterious disease capable of silently destroying the kidneys of otherwise healthy young adults now apparently emerging among outdoor workers in Texas, experts are stressing early detection.
Paidi recommends that people working in agriculture or other outdoor occupations in hot climates have their kidney function checked at least twice annually.
“A simple blood test for creatinine (a waste product normally filtered from the blood by the kidneys) and a urine test for protein can catch early changes long before symptoms appear,” he said.
For a disease that can remain virtually invisible until patients are approaching kidney failure, those early tests could provide one of the few opportunities to detect the damage before it becomes irreversible.
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