Chronic kidney disease of unknown causes in Mesoamerica. An approach from the Perspective of Medical Geology.

In Mesoamerica, new cases of chronic kidney disease of unknown cause (CKDu) are increasing each year, including those requiring renal replacement therapy and deaths from this cause. It tends to manifest in younger people, who present symptoms late, in stages 4 and 5. Geographically, cases occur in specific well-recognized areas of Mesoamerica: low-lying areas associated with the Pacific coast, warm and dry regions with high wind traffic, volcanic activity and sandy soils. This comprehensive review was conducted without the use of generative AI (artificial intelligence) to provide novel criteria regarding potential environmental and epidemiological risk factors currently recognized in the global scientific literature. The factors investigated were approached from the novel perspective of medical geology, which addresses the risk to populations affected by different environmental variables specific to their living environment, presenting a similar risk under the same exposure scenario. According to the literature found related to CKDu, it is suggested that nephrotoxic heavy metals in medium and low doses present in sandy soils, typical of the specific areas of high prevalence of the disease in Mesoamerica, India and Sri Lanka contribute with genotoxic and epigenetic damage from various perspectives as common causal agents, which were quantified in some sites of prevalence of the disease.