Mysterious Kidney Disease Slays Farmworkers In Central America

This morning from U.S. National Public Radio...

Manuel Antonio Tejarino used to be a lean, fit field hand. During the sugar cane harvest, he'd swing a machete for hours, hacking at the thick, towering stalks.

Now Tejarino is slumped in a faded, cloth deck chair outside his sister's house on the outskirts of Chichigalpa, Nicaragua.

Tejarino's kidneys are failing.

...

This form of kidney failure, known as insuficiencia renal cronica in Spanish (or in English), is now found from southern Mexico to Panama... But it occurs only along the Pacific coast.

Print excerpts of the story, photos, and audio (7 min 47 sec).

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I question calling it a 'disease'

Renal failure can result from acute kidney injury caused by toxic overload. I suspect the principle toxic culprits here are alcohol and its congeners (ketones, aldehydes) present in cheap 'guaro'. We drink to feel good, to forget our sufferings. Too much is intoxication. All poor Nica men I know drink heavily, and not always the good quality rum like FdC

Work conditions aggrevate these injuries. The searingly hot, humid tropics. Too little good water to drink nor the break times & shade for them to briefly rest during work hours (rotate crews). That plus replacement of electrolytes lost sweating. Exposure to herbicides in the fields would certainly count as more toxic overloading.

These poor men are push beyond their limits in the cane fields, but it's a job.

There should be a national law that only allows individuals to work 2 or 3 consecutive years of such unreasonably hard labor. (Check with fingerprint scanners.) There are other jobs unskilled labor can do, once the cost restriction on family mobility are overcome.

following the NYTimes' article of 5/8/14

. . . titled, "Deadly Illness in Nicaragua Baffles Experts" by Heather Murphy, there were several excellent comments by readers. I will quote the best (IMO) here and below.

from nyctheatrelover, posted 5/9/14

"The article mentions no ill women. Either they are immune, or the disease cannot be transferred between husbands and wives. Therefore it is something absorbed in the fields and only in the fields. That points to chemical compounds (including herbicides, pesticides, fertilizers...).

from Richard P. Handler, M.D. of Evergreen, Colorado, posted 5/9/14

"If this disease only affects or principally affects men, not women, suspect a nephrotoxic adulterant in cheap rum. Epidemiology is remeniscent of the cobalt cardiomyopathy in Quebec 50 years ago from a regionally popular beer."

...

""The article mentions no ill women. Either they are immune, or the disease cannot be transferred between husbands and wives. Therefore it is something absorbed in the fields and only in the fields. That points to chemical compounds (including herbicides, pesticides, fertilizers...)."

I am not sure I agree with.

Firstly, it is not uncommon for women to become exposed to contaminants which their men have become exposed to in the workplace, for example, by washing their husbands´contaminated clothes.

Secondly, women in Nicaragua do apparently suffer high rates of kidney problems. I know that recurring kidney infections are a common diagnosis here, which would indicate that their renal function has been compromised.

Thirdly (and somewhat pedantically) the fact that the article mentions no ill women doesn´t necessarily mean that the woman are not ill.

from patoruzu of Georgia, USA, posted 5/9/14 NYT

"It's no coincidence that sugar cane workers are the most affected. They are routinely drenched with the herbicide glyphosate (aka Round Up), which is used not just for weed control but also as a ripening agent, being sprayed over the sugar cane prior to harvest. It is known that glyphosate damages kidneys as part of its multiple actions as strong chelating agent. The development and increase in severity of this disease in Nicaragua mirrors the increase in use on glyphosate in sugar cane. The weather is as hot (or hotter) on Nicaragua's Eastern shore, and nobody gets sick there. Elsewhere in Central America, this problem is also widespread among sugar cane field workers.

Please see the Open Access papers

"Glyphosate, Hard Water and Nephrotoxic Metals: Are They the Culprits Behind the Epidemic of Chronic Kidney Disease of Unknown Etiology in Sri Lanka?" Int. J. Environ. Res. Public Health 2014, 11, 2125-2147; doi:10.3390/ijerph110202125

"Glyphosate’s Suppression of Cytochrome P450 Enzymes and Amino Acid Biosynthesis by the Gut Microbiome: Pathways to Modern Diseases" Entropy 2013, 15, 1416-1463; doi:10.3390/e15041416

from Sam of Chicago, posted 5/9/14 NYT

"I lived and worked in the mountainous regions of Nicaragua for two years as a geologist and they had the same kidney problems there too. I think when agencies do more research they will find out that dehydration plays a huge role. I would be hiking through the mountains for 8+ hours and have local field helpers carrying rock samples and cutting brush for me. On some hot days, I would drink over a gallon of water out in the field, and most of the field hands never brought any water. They had access to water at their houses, and had containers, but they told me they never needed it. They would bring small bottles of water and swish and spit some, but would rarely actually swallow any of it.

"To be fair, in a sense they didn't "need" it. They would get along and be chipper and reasonably exhausted by the end of the day, but if I had tried to do the same thing without drinking water I would have had heat stroke.

"But simply because they are not having acute reactions doesn't mean they aren't stressing out their kidneys to an extreme.

"The other thing is that even after explaining why they needed to drink more water, they wouldn't listen to me. They felt ok at the end of the day, and that was all the evidence they needed. I think educational campaigns could go a long way for these sugar cane workers. At least to just rule out dehydration."

from Kerry of Austin, posted 5/9/14 NYT

"I started a charity in Nicaragua in 2007 mainly to bring clean water to several towns but in part to open a free dialysis clinic to provide relief from this mysterious disease in the mining area, possibly the one mentioned in the article. As a former executive with the mining company I was incredulous that this disease had never been seriously studied and after numerous attempts with health organizations, both local and international, to get something started, I gave up. People blamed everything from the water, the mines, the pesticides and the dust for the disease but nobody really knew.

"Our clinic was unable to get a permit to open. In a nearby city, a for-profit clinic was owned by the companion of the woman in the health ministry whose approval we needed. We wound up giving our dozen refurbished dialysis machines to the existing clinic rather than let them gather dust in a warehouse. I'm very pleased to see that this is finally getting studied and I hope the cause is found soon."