Texas doctors report rise in kidney disease of unknown origin

Doctors in Texas say they have seen an increasing number of otherwise healthy young men coming in on the brink of organ failure. The health care practitioners told Texas Monthly they believe the culprit is CKDu, or chronic kidney disease of unknown origin, an unexplained form of kidney disease that can quickly turn deadly.

The disease has also been called Mesoamerican Nephropathy, a reference to Central America, where it is more typically found. It has also been identified in Sri Lanka. Researchers are now concerned it is growing in the United States, especially among agricultural workers and laborers.

People with CKDu do not have the classic risk factors of kidney disease, like hypertension or diabetes. Most people affected are Latino men ages 20 to 60. Often, they work under extreme conditions.

“In Central America, CKDu is hypothesized to be associated with occupational and environmental exposures mainly affecting young men working in lowland agricultural settings, most notably sugarcane harvesters,” researchers published in a 2023 public health journal.

It is not exactly clear why the disease impacts so many agricultural workers. One hypothesis, explained in a 2024 research article, is that it has to do with extreme heat stress or chronic dehydration.

Epidemiologist Rebecca Fischer told Texas Monthly more research is needed, and the origins of CKDu are still a “mystery to solve.”

“We are quite far, still, from understanding exactly what’s going on,” Fischer said.

In areas where it is endemic, CKDu can be devastating. In El Salvador, hospitalizations for the condition jumped by 50% between 2005 and 2012, making it the No. 1 cause of hospitalization, according to the International Society of Nephrology. Many of those hospitalized are young, even under 19.

CKDu often is not caught until the late stage, when the kidneys are near failure. People with CKDu need dialysis or a transplant to stay alive, but those options are not always available for the vulnerable populations who are most affected.

“Undocumented immigrants in the United States cannot receive routine outpatient dialysis care in most U.S. states and rely on emergency dialysis,” researchers at Boston University said. These cases are also not reported in the national renal systems database.

For similar reasons, existing data “likely underestimates the true burden of unexplained ESKD,” or end-stage kidney disease, the researchers wrote.