Back
In Tlaxcala, a state in central Mexico, an increase in the prevalence of kidney diseases such as chronic kidney disease (CKD) in young adults has been observed in recent years. In 2016, the Tlaxcala Health Secretariat reported a prevalence of terminal CKD in young people between 15 and 24 years old, which corresponds to a third (37.5%) of the total population of patients in the state. These kidney diseases occur in a population without an apparent family history or traditional clinical symptoms. In a pilot study carried out in Apizaco, municipality of the state of Tlaxcala, also in 2016 in children aged 6 to 15 years, a prevalence of 4.3% of CKD was reported, which was apparently related to risk factors due to exposure to environmental contaminants such as heavy metals. This work aimed to evaluate the relationship between socioeconomic and environmental risk factors, with the alteration of kidney damage markers observed in the population.
A cross-sectional study was carried out in healthy adolescents (n=914) who underwent a socioeconomic questionnaire, and a complete physical examination, the glomerular filtration rate (eGFR) was calculated by Bedside Schwartz and the concentrations of metals and metalloids by ICP-masses. Metabolites related to pesticide exposure were determined. And biomarkers of early kidney damage (KIM-1, NGAL, Cystatin-C, etc.) with luminex MagPix technology.
A glomerular filtration rate (eGFR) <75 ml/min/1.73m2 was confirmed in 67 participants (7.3%), while 137 individuals (15%) presented hyperfiltration (>150 ml/min/1.73m2). The male sex had a higher prevalence of decreased GFR (p<0.001). The presence of arsenic, lead, vanadium, molybdenum, and selenium, among other elements (13 elements) was observed in the urine of the participants; while the presence of metabolites related to pesticide exposure in the participants' samples, including malathion, parathion, and glyphosate, etc., were also determined. Finally, the presence of biomarkers of early kidney damage such as KIM-1, NGAL, Cys-C, OPN, and α1-MG was determined.
The presence of blood, microalbumin, GFR, and the presence of biomarkers of early kidney damage were observed, related to the presence of elements such as vanadium, arsenic, fluoride, copper, etc. Pesticides, even without reference values for the pediatric population, were determined in more than 80% of individuals. The presence of these xenobiotics in high concentrations seems to suggest an alteration in the biodistribution and/or bioavailability of other essential or toxic substances in the body, causing renal alterations and apparently undermining renal function.