Chronic Kidney Disease of Unknown Cause in Agricultural Communities | NEJM

Chronic Kidney Disease of Unknown Cause in Agricultural Communities | NEJM

In recent years, numerous cases of chronic kidney disease have emerged among agricultural workers, as well as among others performing manual labor, in various regions of the world. The disease does not appear to be due to the classic causes of kidney disease (e.g., diabetes, hypertension, and glomerular disease). In this review, we describe the clinical presentation and epidemiology of chronic kidney disease that is endemic in this workforce in these areas, as well as possible causes. The disease is strongly associated with working and living in a hot environment, but whether the cause is a toxin, an infectious agent, a heat-associated injury, or a combination of factors is not yet known. We also discuss some of the assumptions and limitations in our understanding of chronic kidney disease in agricultural communities.