Date of Award


Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)


Physician Assistant Studies

First Advisor

Alicia Quella


An epidemic of chronic kidney disease (CKD) in Central America and Nicaragua is referred to as Mesoamerican nephropathy (MeN). It’s estimated that the death toll for MeN over the past two decades has reached at least 20,000. Nicaragua is included in the 10 highest overall mortality rate from kidney disease in the world. MeN disproportionately affects young, male agricultural workers who do not exhibit traditional risk factors for CKD such as hypertension and diabetes. A consistent risk factor for MeN is heavy manual labor in the heat, often temperatures over 35 °C with high humidity. Many reasons have been proposed when trying to explain the cause of the disease. Multifactorial features of dehydration, heat stress, and nephrotoxins may all contribute in some way, however most literature agrees dehydration and heat stress are the main players. There is already a great awareness about this disease due to advocacy work from nonprofits, published literature, and lobbying citizens such as Carmen Rios. However, there is a significant disagreement between Nicaraguan providers about the cause of the disease and the way to approach it through prevention. This disagreement leads to misconceptions in the community.



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