Smpokou, Evangelia-TheanoGonzález-Quiroz, MarvinMartins, CarlaAlvito, PaulaLe Blond, JenniferGlaser, JasonAragón, AuroraWesseling, CatharinaNitsch, DorotheaPearce, NeilNorman, JillLindh, ChristianMorton, JackieCaplin, Ben2020-04-232020-04-232019-09-27Occup Environ Med . 2019 Dec;76(12):920-926. doi: 10.1136/oemed-2019-105772. Epub 2019 Sep 271351-0711http://hdl.handle.net/10400.18/6494The authors are grateful to the participants of the study, the study team in Nicaragua for sample collection and preparation and all those who contributed with ideas and the analyses of samples, Kate Jones, Elizabeth Leese, James Staff, Howard Mason and Shahwaiz Iqbal from HSE, Buxton, UK, Moosa Faniband from Lund University, Sweden, and Kristina Jakobsson from University of Gothenburg, Sweden.Objectives: There is an epidemic of Mesoamerican nephropathy (MeN) in Central America, where sugarcane production is prominent. Numerous causes are proposed, but to date limited evidence supports any one hypothesis. A nested case-control study using biosamples from a rural, community-based follow-up study of 350 young adults from Northwest Nicaragua at risk of MeN was conducted with the aim of characterising the associations between urinary concentrations of metals, pesticides and mycotoxins from samples collected in the first 6 months and decline in kidney function over 2 years. Methods: Urine samples collected at baseline (pre-sugarcane harvest) and the first 6 month follow-up (post-sugarcane harvest) visit were tested. Twelve metals and metalloids (aluminium, total arsenic, cadmium, chromium, cobalt, copper, lead, manganese, mercury, selenium, silicon and strontium) were analysed by inductively coupled plasma-mass spectrometry. Twelve pesticides or their metabolites (2,4-dichlorophenoxyacetic acid, 3-phenoxybenzoic acid, 4-fluoro-3-phenoxybenzoic acid, chloro-3,3,3-trifluoro-1-propen-1-yl-2,2-dimethylcyclopropanecarboxylic acid, cis/trans 3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, ethylenethiourea, glyphosate, 4-chloro-2-methylphenoxy acetic acid, 3-hydroxy-pyrimetanil, 5-hydroxytiabendazole, hydroxy-tebuconazole and 3,5,6-trichloro-2-pyridinol) and two mycotoxins (ochratoxin A (OTA) and citrinin (CIT)) were analysed by liquid chromatography coupled-mass spectrometry. Differences in the creatinine-corrected urinary concentrations of the measured exposures between outcome groups (participants with stable vs declining kidney function) were examined. Results: Elevated levels of aluminium and total arsenic as well as metabolites of several pesticides were detected across the population. No differences were identified between the declining and stable groups in the levels of metals or pesticides tested. OTA and CIT were below the limit of detection. Conclusions: The tested metals, metalloids, pesticides and mycotoxins were not associated with loss of kidney function in participants at-risk of MeN.engChronic Kidney Disease of Unknown Origin (CKDu)Environmental ToxinsMesoamerican Nephropathy (MeN)NephrotoxicityPesticidesSegurança AlimentarAvaliação de RiscoToxicologiaSaúde Humanajournal article10.1136/oemed-2019-105772