Proteinuria e insuficiencia renal crónica en la costa de El Salvador: detección con métodos de bajo costo y factores asociados / Proteinuria and chronic renal failure in the coast of El Salvador

RESUMEN

Objetivos: El Salvador tiene alta mortalidad por insuficiencia renal crónica (IRC),hay poca información y los recursos son escasos. Estudios previos sugieren alta prevalenciaen poblaciones con características específicas varones agricultores de zonascosteras con exposición a pesticidad y etilismo frecuente. Nuestro objetivo fue detectarcasos de IRC en esta población utilizando proteinuria como cribado inicial económico,investigando asociaciones con tales características y comparándolos con otrapoblación alejada de la costa.Métodos: Realizamos un estudio transversal en varones voluntarios de ambasregiones considerando edad, ocupación agrícola, exposición a pesticidas, etilismofrecuente, antecedentes médicos, presión arterial, glucemia y proteinuria en muestraal azar. En proteinúricos de la costa medimos hemoglobina y creatinina sérica buscandoIRC. Investigamos asociación de proteinuria e IRC con estas variables dependientesempleando un modelo de regresión logística y prueba de Chi2.Resultados: Incluimos 291 varones de la costa y 62 de la zona alta 35 y 16% deltotal de sus comunidades, respectivamente. Presentaban proteinuria 133 (45,7%) y 8(12,9%) casos. Diagnosticamos IRC a 37 (12,7%) varones de la costa, con creatinina2,64 ± 2,5 mg/dl, hemoglobina 12,32 ± 1,9 g/dl y un 81,15 con proteinuria 15-30mg/l. Solamente 14 (37,8%) presentaban diabetes y/o hipertensión, los demás(62,2%) sin etiología clara. Sólo uno estaba previamente diagnosticado. Ser agricultor,la exposición a pesticidas y el etilismo frecuente resultaron características muycomunes y no predictoras ni asociadas a presentar proteinuria o IRC. Discusión: La prevalencia de IRC en varones agricultores de la costa es muy alta12,7% como mínimo, pero fácilmente detectable con métodos económicos sencillos.Etiologías habituales, diabetes e hipertensión, no explican tal prevalencia. La exposicióna pesticidas y el etilismo tampoco parecen relacionados. La IRC es generalmentemoderada, asintomática y poco proteinúrica, de posible origen intersticial. Debenconducirse estudios más amplios investigando factores ambientales, ocupacionalesy hereditarios

ABSTRACT

Objectives: El Salvador has high mortality rates from chronic kidney disease (CKD).The actual prevalence and causes remain unknown and local resources are scarce.Previous studies have suggested very high prevalence in specific populations adultmale farmers living in the coastlands, with high frequency of pesticides exposure andalcohol consumption. This population has low incomes and poor healthcare accessibility.Our aim was to detect CKD cases in this population using proteinuria as an inexpensiveinitial screening, investigating associations with those characteristics andcomparing them with another population from the midlands.Methods: We performed a transversal study on volunteer men from both regions,taking into consideration the variables age, farmer living, pesticides, exposure, alcoholconsumption, medical past history, blood pressure level, glycemia and proteinuriain a random urine sample.Coastland men with proteinuria were additionally screenedfor CKD measuring hemoglobin and serum creatinine le vels. Finally, we employed alogistic regression model, and Perason’s Chi2 to investigate associations betweenthose variables and the presence of proteinuria or CKD.Results: We included 291 men from the coastlands and 62 from the midlands35 and 16% off the total male population from their respective communities. Proteinuria(table I) was found in 133 (45.7%) and 8 cases (12.9%). CKD was diagnosedin 37 (12.7%) coastland men (table III), with mean creatinine 2.64 ± 2.5mg/dl, hemoglobin 12.32 ± 1.9 g/dl and 81.1% with proteinuria 15-30 mg/l.Only 14 (37.8%) out of those 37 CKD patients featured diabetes or hypertension,while the remaining (62.2%) did not appear to have a clear-cut cause for CKD.Only one of them was formerly diagnosed with CKD. Farmer living, pesticidesexposure and alcohol consumption were found to be very common characteristicsin both populations, and were not associated to the presence of proteinuria orCKD (table II and III).Discussion: The prevalence of CKD within the adult male farmers from the Salvadorancoastlands is remarkably high at least 12.7%. There is a large number of undiagnosedcases, but they can be easily detected with inexpensive methods. This highprevalence is not completely explained by usual CKD causes like diabetes or hypertension.In addition, pesticides exposure and alcohol consumption may not be related,too. The disease is moderate, non symptomatic and has fairly mild proteinuria, possibly from interstitial origin. Further research is required to investigate environmental,occupational and hereditary factors, and to determine the real extent of theproblem: