Case-Control Study of Infectious Disease and Mesoamercian Nephropathy in Nicaragua: 2017-2019

Infection with Leptospira spp. bacteria has been proposed as a possible risk factor for developing Mesoamerican Nephropathy (MeN). This notion is biologically plausible, as renal involvement is typical of leptospirosis and is commonly characterized by tubulo-interstitial nephritis and tubular dysfunction. Indeed, there are striking similarities in the demographic, geographic, and temporal distributions of the two diseases.

The main objective of this case-control study is to examine this hypothesis that prior infection with leptospirosis is a risk factor for MeN. Cases and controls have been recruited from adult male and female inhabitants of a mining area in the Department of León in northwestern Nicaragua. Occupations other than mining include small-scale agriculture, cattle-ranching or dairy work, and construction. Based on past surveys, leptospirosis seropositivity in the area is likely on the order of 30%-40%. Survey data and biological specimens have been collected from the more than 300 participants. Laboratory analysis of creatinine, uric acid, glucose, proteinuria, and hematuria was carried out in Nicaragua, and the results have been returned to the study participants. The Centers for Disease Control and Prevention (CDC) is conducting leptospirosis seropositivity testing.

Funding: The study was principally funded from the William F. Milton Fund of Harvard University, with supplemental funds from the Department of Population Medicine of Harvard Medical School. These institutions have no influence over the design, analyses, or conclusions of the study.

Publications: Yih WK, Kulldorff M, Friedman DJ, Leibler JH, Amador JJ, López-Pilarte D, Galloway RL, Ramírez-Rubio O, Riefkohl A, Brooks DR (2019). Investigating Possible Infectious Causes of Chronic Kidney Disease of Unknown Etiology in a Nicaraguan Mining Community. The American Journal of Tropical Medicine and Hygiene.