Chronic Interstitial Nephritis in Agricultural Communities (CINAC)

Excerpt

Chronic interstitial nephritis in agricultural communities (CINAC) is a new form of chronic kidney disease (CKD) with its own etiopathogenesis; not related to other well-known causes of CKD such as diabetes, hypertension, and glomerulopathies. However, the incidence and prevalence of CINAC have reached epidemic proportions. Predominantly, CINAC affects young men but has also been occasionally reported in women and adolescents in countries such as El Salvador, Guatemala, Nicaragua, and Costa Rica in Central America, Egypt in Africa, and Sri Lanka and India in Asia.

This form of CKD of nontraditional causes has been reported from several world regions and has similar clinical and epidemiological characteristics. It is known by various names, such as Central American nephropathy, Salvadoran agricultural nephropathy, Mesoamerican nephropathy, Uddanam endemic nephropathy (India), or CKD of unknown etiology (CKDu) in Srilanka. The term chronic interstitial nephritis in agricultural communities (CINAC) was proposed to describe the disease holistically.

CINAC affects people working in the agricultural sectors of these regions, which are described as CINAC endemic areas.

The socio-economic and occupational determinants such as poverty, exposure to toxic agrochemicals, and hot tropical climates correlate with clinical characteristics that help make the diagnosis. The disease most frequently occurs in men and affects women, children, and adolescents who live in these farming communities. In endemic regions, CINAC is noted even in those who do not work in agriculture.

In fact, according to The Pan American Health Organization, Nicaragua and El Salvador have CKD-related estimated mortality rates of 42.8 and 41.6 deaths per 100,000, respectively, which is fourfold higher than any other country. In El Salvador, CKD is the second most common cause of death in young men, with males affected three times more than females.