Jeff Ritterman, M.D. writes: For years, scientists have been trying to unravel the mystery of a chronic kidney disease epidemic that has hit Central America, India and Sri Lanka. The disease occurs in poor peasant farmers who do hard physical work in hot climes. In each instance, the farmers have been exposed to herbicides and to heavy metals. The disease is known as CKDu, for Chronic Kidney Disease of unknown etiology. The “u” differentiates this illness from other chronic kidney diseases where the cause is known. Very few Western medical practitioners are even aware of CKDu, despite the terrible toll it has taken on poor farmers from El Salvador to South Asia.

Dr. Catharina Wesseling, the regional director for the Program on Work and Health (SALTRA) in Central America, which pioneered the initial studies of the region’s unsolved outbreak, put it this way, “Nephrologists and public health professionals from wealthy countries are mostly either unfamiliar with the problem or skeptical whether it even exists.”

Dr. Wesseling was being diplomatic. At a 2011 health summit in Mexico City, the United States beat back a proposal by Central American nations that would have listed CKDu as a top priority for the Americas.

David McQueen, a US delegate from the Centers for Disease Control and Prevention who has since retired from the agency, explained the US position.

“The idea was to keep the focus on the key big risk factors that we could control and the major causes of death: heart disease, cancer and diabetes. And we felt, the position we were taking, that CKD was included.”

The United States was wrong. The delegates from Central America were correct. CKDu is a new form of illness. This kidney ailment does not stem from diabetes, hypertension or other diet-related risk factors. Unlike the kidney disease found in diabetes or hypertension, the kidney tubules are a major site of injury in CKDu, suggesting a toxic etiology. [Continue reading…]