Environment and chronic kidney disease in farmers

The prevalence of chronic kidney disease (CKD) has been on the rise worldwide. Epidemiological studies performed primarily in Central America and South Asia have reported high prevalence of CKD among young and middle-aged men working in agricultural communities. The clinical features do not appear linked to any classical CKD risk factors, such as hypertension, diabetes, or chronic nephritis. The disease develops and progresses as interstitial nephritis, without showing noticeable symptoms or high levels of proteinuria. Pathologically, the disease essentially represents chronic interstitial nephritis and is termed chronic interstitial nephritis in agricultural communities (CINAC). The potential causes of CINAC include: (1) heat stress-related factors associated with increased ambient temperatures resulting from global warming; and (2) factors connected with exposure to agrochemicals and/or pesticides. Global warming and environmental pollution will undoubtedly pose a significant health risk to farmers, and heat stress during farm work could easily result in the development and progression of CKD. Japanese agricultural regions evidently will not be spared from global environmental changes. For future epidemiological studies, researchers should establish a more comprehensive analytical method that can incorporate additional risk-factor variables, such as occupational history (including agricultural work) and ambient temperature.

Discharging loin sinus: Unusual manifestation of ruptured horseshoe kidney

We present a 20-year-old man with a chronic discharging sinus in the left loin arising from a horseshoe kidney with a large pelvicalyceal calculus on its left side. The left moiety was non-functional, so a left hemi-nephrectomy, together with excision of the whole fistula tract, was carried out. Histopathology was suggestive of chronic interstitial nephritis. Patients with horseshoe kidney are prone to development of renal stones and their associated complications. The unfamiliar anatomy of horseshoe kidneys may increase the complexity of any surgical procedure. Radiological investigations are pivotal in identification of the underlying renal pathology; they may also delineate a fistula tract as in our case.

Karyomegalic interstitial nephritis: diagnosed only when suspected

Background Karyomegalic interstitial nephritis (KIN) is an uncommon cause of chronic interstitial nephritis that eventually progresses to end-stage renal disease. Overall less than 50 cases have been reported in the literature. Case presentation We describe an asymptomatic 25-year-old gentleman with a family history of chronic interstitial nephritis who came to check the status of his kidney functions. On evaluation, he was found to have chronic interstitial nephritis which could not be attributed to a specific etiology. Renal biopsy confirmed the diagnosis of KIN. Conclusion KIN remains underdiagnosed. It is important to recognize this entity because of the familial nature, a wide range of differential diagnoses, and prognostic implications. A high index of clinical suspicion is necessary to perform renal biopsy which remains the gold standard for the diagnosis of KIN.

Pathology of Ground Squirrels in a Research Colony

This paper presents a retrospective review of the postmortem findings in a colony of wild-caught ground squirrels used in medical research. The species included in this study were Richardson's ground squirrel Urocitellus richardsonii, Columbian ground squirrel Urocitellus columbianus and golden-mantled ground squirrel Callospermophilus lateralis. The pathologic findings in 160 ground squirrels from this colony demonstrated a wide variety of conditions, with chronic nephritis and hepatic adenomas being the most frequent overall. All animals with gross lesions of chronic interstitial nephritis had both glomerular and tubulointerstitial disease upon microscopic examination. As the first review of pathology in a research colony of ground squirrels. this study provides data for use in comparative studies about rodent diseases and important information for those who maintain such animals for research.