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Principal Investigator: Jennifer Crowe
Organization: UNIVERSIDAD NACIONAL, COSTA RICA
Fiscal Year: 2024
Award: $450,000
Funding agency: National Institute of Diabetes and Digestive and Kidney Diseases
PROJECT SUMMARY
Chronic kidney disease of unknown origin (CKDu) is highly prevalent in several tropical
regions, including Central America where it is most common among young adult males
working in sugarcane and other agricultural activities. It has taken a terrible toll on families
living in vulnerable conditions in rural areas. Despite efforts to study CKDu over the last two
decades, its causes are not fully understood and the disease continues to claim lives and
overwhelm healthcare systems. This project aims to identify risk factors and predictors for
estimated glomerular filtration rate (eGFR) decline among young individuals with and without
CKDu in rural endemic areas in four Central American countries: Costa Rica, Panama,
Nicaragua and Guatemala. We will comprehensively assess multiple risk factors related to
1) strenuous manual labor under heat stress with inadequate rest; 2) social determinants
(e.g., poverty, malnutrition, low birth weight); 3) vector-borne or zoonotic diseases; and 4)
exposure to known or novel toxins (e.g., heavy metals, agrochemicals, silica). We will also
collect bio-banked specimens to assess genetic risk factors and novel biomarkers of acute
kidney injury (AKI), as determined by the NIH Chronic Kidney Diseases of Uncertain Etiology
(CURE) consortium. As a Field Epidemiology Site, our primary study aims are: (a)
identification of cases and controls in endemic agricultural communities; (b) longitudinal
follow-up of both cases and controls; and (c) biopsies in a subset of individuals. Our
proposal takes advantage of the SALTRA network (Central American Program for Health,
Work and Environment). SALTRA has nearly 20 years of experience conducting research in
the region and has longstanding relationships with local communities, organizations and
governmental organizations, public health authorities and local nephrologists on the front
lines of fighting this disease.
Terms: <19S Gamma Globulin><7S Gamma Globulin><Active Follow-up><Acute Renal Failure with Renal Papillary Necrosis><Agricultural Chemicals><Agrochemicals><Area><Biological Markers><Biopsy><Blood><Blood Reticuloendothelial System><Body Tissues><Case-Base Studies><Case-Comparison Studies><Case-Compeer Studies><Case-Referent Studies><Case-Referrent Studies><Case/Control Studies><Causality><Central America><Central American><Chronic Kidney Failure><Chronic Renal Disease><Chronic Renal Failure><Collaborations><Collection><Communities><Costa Rica><Country><Coupled><Cristobalite><DNA><DNA seq><DNA sequencing><DNAseq><Data><Deoxyribonucleic Acid><Deposit><Deposition><Detection><Disease><Disease Progression><Disorder><Dryness><Electron Microscopy><Enrollment><Environment><Environmental Exposure><Environmental Toxin><Environmental and Occupational Exposure><Epidemiology><Espanol><Etiology><Exposure to><Factor Analyses><Factor Analysis><Family><Fever><Genetic><Genetic predisposing factor><Glomerular Filtration Rate><Guatemala><Health><Health Care Providers><Health Care Systems><Health Personnel><Healthcare Providers><Healthcare Systems><Healthcare worker><Heat Stress><Heavy Metals><Histopathology><IgG><IgM><Immunoglobulin G><Immunoglobulin M><Impoverished><Incidence><Individual><Infectious Agent><Injury to Kidney><Institution><Kidney><Kidney Urinary System><Long-term cohort><Longitudinal cohort><Longterm cohort><Low Birth Weight Infant><Malnutrition><Manuals><Mass Photometry/Spectrum Analysis><Mass Spectrometry><Mass Spectroscopy><Mass Spectrum><Mass Spectrum Analyses><Mass Spectrum Analysis><Measurement><Measures><Metals><Morphology><NIH><National Institutes of Health><Natural History><Nicaragua><Non-Polyadenylated RNA><Nutritional Deficiency><Panama><Patients><Poverty><Proteinuria><Public Health><Pyrexia><RNA><RNA Gene Products><RNA Seq><RNA sequencing><RNAseq><Renal Tissue><Renal function><Research><Research Specimen><Rest><Ribonucleic Acid><Risk><Risk Factors><Risk Marker><Role><Rural><Saccharum><Sand><Silica><Silicon Dioxide><Site><Spanish><Specimen><Spottings><Sugarcane><Tissues><Toxic Environmental Agents><Toxic Environmental Substances><Toxin><Tridymite><Tubular><Tubular formation><Undernutrition><United States National Institutes of Health><Universities><Visit><Work><Zoonoses><Zoonotic><Zoonotic Infection><acronyms><active followup><acute kidney injury><adult youth><agricultural activity><agricultural community><agricultural region><authority><bio-markers><biobank><biologic marker><biomarker><biorepository><case control><case-controlled><case-controlled studies><causation><chronic kidney disease><design><designing><dietary deficiency><disease causation><enroll><environmental toxicant><epidemiologic><epidemiological><experience><febrile><febris><fighting><follow up><follow-up><followed up><followup><genetic risk assessment><genetic risk factor><health care personnel><health care worker><health provider><health workforce><healthcare personnel><infectious organism><inherited factor><kidney biopsy><kidney function><kidney injury><low birth weight><low birthweight><male workers><malnourished><medical personnel><member><new marker><novel><novel biomarker><novel marker><nutrition deficiency><nutrition deficiency disorder><nutritional deficiency disorder><pathogen><population based><programs><prospective><renal><renal biopsy><renal injury><risk predictor><risk predictors><rural area><rural location><rural region><social determinants><social role><sociodeterminant><transcriptome sequencing><transcriptomic sequencing><treatment provider><vector-borne><vectorborne><working males><working men><young adult><young adulthood>