User:Saltrabook/Occupational medicine in general practice
CKDu to be reported as an occupational disease
In the past two decades, the subregion of Central America has reported an increasing number of cases of people suffering and dying from chronic kidney disease (CKD). Among these cases, described a type of chronic renal disease etiology is not linked to the most common causes of CKD, such as diabetes mellitus and hypertension Lancet.pdf May 2014 Have been made numerous descriptive epidemiologic studies to characterize and measure factors associated with the disease. These studies have suggested several causal hypotheses ranging from environmental causes, habits and personal habits, especially those of the poorest farm workers. Most of the information and research findings of the past five years were presented at the conference organized by SALTRA in November 2012 and in April 2013 conference in El Salvador  . The most widely accepted causal hypothesis of the epidemic are repeated episodes of heat stress and dehydration during heavy work in hot climates. Possible co-factors that interact with heat stress or influence the progression of CKD include excessive use of anti drugs - nonsteroidal inflammatory and fructose consumption in rehydración fluids. Possible factors contributing to the epidemic include inorganic arsenic, leptospirosis, exposure to pesticides and hard water. According to a study of 8 clinical cases in El Salvador indicates that man in kidney disease not previously recognized with both glomerular damage and tubulointerstitial compartments is identified . There is consensus that the disease occurs mainly in agricultural areas and is an occupational disease. However, there is a lack of efforts to define a set of clinical guidelines to evaluate which cases should be compensated as occupational disease and none has been seen at an occupational specialist clinic. The research plan in Panama is based on an ccupational medical view with the main objective to answer the questions:
- Should the disease be recognised as an Occupational Disease under certain conditions?
- Which are the criteria for recognition, exposure time, type of exposure etc?
The research plan
- An evaluation of the size of the problem in Panama, by estimating the percentages of CKDu of all cases of CKD in hospitals and dialysis centres.
- A clinical case study diagnosed as chronic renal disease of unknown etiology as the first step to assess 'whether it should be recognised as an occupational disease.'
- An etiological case-control study as the second step together with the existing evidence to decide whether the disease should be classified as an occupational disease under certain condtions - years in the work, no competing causal factors etc.
- Collaboration with researchers from other countries is very very welcome
- Ramirez-Rubio O, McClean MD, Amador JJ, Brooks DR. An epidemic of chronic kidney disease in Central America: an overview. Journal of epidemiology and community health. 2013;67(1):1–3.
- Ventres W. Chronic kidney disease among agricultural workers in Central America. Am J Public Health. 2014 Mar;104(3):e1.
- Wernerson A, Wijkström J, Elinder C-G. Update on endemic nephropathies. Curr Opin Nephrol Hypertens. 2014 May;23(3):232–8.