Chronic Kidney Disease of Unknown Etiology Emerges Among Young Outdoor Workers in Texas

Physicians at Harris County safety-net hospitals in Houston, including Ben Taub, have for over a decade observed clusters of young men in their 20s and 30s—primarily undocumented immigrants from Mexico and Central America working in construction, roofing, and other strenuous outdoor trades—presenting with end-stage kidney failure lacking traditional risk factors like diabetes or hypertension. A review of county hospital records from 2012–2015 found that roughly one in six emergency dialysis cases among uninsured or undocumented patients had no identifiable cause, consistent with chronic kidney disease of unknown etiology (CKDu), also known as Mesoamerican nephropathy.

This pattern mirrors documented epidemics among agricultural laborers in Central America (e.g., sugarcane workers in Nicaragua, El Salvador, and Costa Rica) and parts of South Asia, where heat stress, repeated dehydration, and intense physical labor are leading hypothesized contributors, potentially compounded by pesticides, agrochemicals, or other toxins. Researchers, including Dr. Marvin Gonzalez-Quiroz at UT San Antonio, describe a mechanism of recurrent acute kidney injury from occupational heat exposure accumulating into chronic damage; a 2019 New England Journal of Medicine perspective labeled CKDu a "sentinel disease in the era of climate change."

Diagnosis remains one of exclusion, relying on patient work history and ruling out other causes, as no specific test exists. Symptoms often appear only after significant damage, with patients facing lifelong dialysis. Experts like Dr. Richard J. Johnson (University of Colorado) and Dr. Gokul Paidi recommend regular creatinine and urine protein screening for at-risk outdoor workers. Pilot studies, such as those examining Hispanic laborers in Houston, and ongoing research in San Antonio construction workers underscore the need for better surveillance amid challenges like undocumented status limiting healthcare access. While exact prevalence in the U.S. South remains unclear due to underreporting, the emergence ties into broader concerns over heat-related occupational health in warming climates.