Epidemiology of Acute Kidney Injury in Latin America

https://doi.org/10.1016/j.semnephrol.2008.04.001Get rights and content

Summary

There is little reliable information on the epidemiology of acute kidney injury (AKI) in Latin America. It is generally assumed that AKI in the developing world affects mainly young and previously healthy people, with an etiologic spectrum relying on particular socioeconomic and environmental conditions. Transmissible diseases such as leptospirosis, malaria, dengue, diarrhea, among others, are recognized as important causes of AKI in these areas. On the other hand, in large cities and university hospitals in Latin American, the AKI spectrum is similar to that seen in developed countries. Large studies are needed to improve our knowledge to design preventive strategies for this potentially lethal disease that affects all population subgroups, from the socially and economically vulnerable to the wealthy. In this article the available information regarding AKI epidemiology in Latin America is reviewed. Data obtained by the Latin American Acute Renal Failure Commission from the Latin American Society of Nephrology through surveys performed in 1997, 2000, and 2004 are reported. Finally, 3 particular medical conditions frequently associated with AKI in Latin America are reviewed.

Section snippets

Epidemiology of AKI in Latin America

Approximately 4 billion of the world's 6.4 billion people live in developing countries. Malnutrition, high demographic growth rates, limitations in urban infrastructure, prevalence of agriculture associated with a low industrialization level, high illiteracy rates, and low technology are all well-recognized indicators of underdevelopment in most of these countries.

Latin America is a subcontinent composed of 20 countries, with a wide diversity of cultures, languages, geography, and a profound

LAARF Commission Data

The LAARF Commission was founded in 1996 to improve the understanding of AKI in the region, particularly its epidemiology, to identify the infrastructure and human resources, and the treatment modalities and technology available in the region. Given the paucity of data and the importance of having reliable epidemiologic information to design preventive strategies to offer human and infrastructural resources in accordance with the actual needs, the LAARF Commission performed 3 surveys.

The first

AKI and Leptospirosis

Leptospirosis, a zoonosis distributed worldwide, is caused by spirochetes belonging to the genus Leptospira. There are more than 200 pathogenic serovars of Leptospira and its prevalence occurs in humid tropical and subtropical areas, where most Latin American countries are located, making this infection a major public health burden, concerning human and veterinary medicine. Because of recent changes in meteorologic conditions with global warming, the World Health Organization has included

Dengue Fever

Dengue is an acute febrile disease, caused by an arbovirus, transmitted primarily by mosquitoes, with a benign evolution in most cases. It is the most important urban arboviral disease, affecting millions of people in all continents, except Europe. It is more prevalent in tropical and subtropical areas where the environment is favorable for the mosquito's development. The main dengue vector is the Aedes aegypti female mosquito. The male mosquito does not transmit the disease because they feed

Animal Venom–Induced AKI in Latin America

Severe AKI has been reported after accidents with snakes, insects (bees and caterpillars), and spiders in Latin American countries. Currently, they represent a small percentage of AKI cases in many tertiary hospitals and in large cities, but animal venom may be an important cause of AKI in certain geographic areas or specific hospitals in Latin America. Moreover, this sort of AKI frequently occurs in young, previously healthy, and productive population members.

The large majority of animal

Acknowledgment

The authors are grateful to Livia C. Burdmann for the excellent grammar review of the manuscript.

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      The increase in serum venom levels is also correlated with high creatinine serum levels, which corroborates the study by Albuquerque et al. (2019), who suggested that a direct nephrotoxic action of the venom may be involved in the development of AKI. In another study (Albuquerque et al., 2014), it is stated that the nephrotoxic action of Bothrops venom on the kidney occurs within a few hours, and may cause complications in the renal parenchyma via hemodynamic disturbances, immunological reactions (Yu et al., 2008), which indicates that a direct envenoming effect into the kidney cannot be ruled out (Albuquerque et al., 2013; Burdmann et al., 1993). However, we did not find these associations in urine.

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      Delayed recognition and treatment of sepsis; the unavailability of diagnostics tools or a higher level of care; limited access to antivenom and antibiotics, including highly active antiretroviral therapy; and the inability to provide timely and monitored management of hyperkalemia, acidosis, and fluid overload with diuretics increase AKI incidence, likely escalate the requirements for dialysis treatment, and lead to higher mortality.13,14 Tropical infections,16,21 community-acquired pneumonia or meningitis, pregnancy-related complications (bleeding, eclampsia, septic abortion),22–26 dehydration due to inadequate access to fluids in frail older adults and young children, exposure to nephrotoxins (e.g., nonsteroidal anti-inflammatory drugs, calcineurin blockers, antiretroviral therapy, antibiotics, or contrast media),27–29 poisons (e.g., arsenic poisoning),30 drug interactions (e.g., calcium-channel blocker plus clarithromycin),31 animal venoms (e.g., snake venom),20 trauma-induced rhabdomyolysis,32 and shock states due to heart failure, hypovolemia, or sepsis1,16,33 are all factors that can result in AKI. AKI following polypharmacy and nephrotoxin exposures in developing countries may be more prevalent, particularly when oversights of pharmacies are not robust due to more limited resources.

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    Dr. Nestor Schor and Dr. Emmanuel A. Burdmann are partially supported by grants from the Foundation for the Support of Research in the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo) and from the National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico).

    This study was performed on behalf of the Latin American Acute Renal Failure Commission, Latin American Society of Nephrology and Hypertension.

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