Ben Taub

A Mysterious Kidney Disease Has Arrived in Texas. Immigration Enforcement Has Made It Harder to Combat. Some staggered through the hospital’s doors, arriving at all hours of day and night. Others were wheeled in on gurneys, their bodies having given out before they could reach the emergency department. Many had collapsed at work—while painting houses, stapling shingles, or paving roads. All had been born in Mexico or Central America, and most complained of a crushing fatigue they could no longer ignore. Routine blood analyses revealed the cause: kidney failure. They would need dialysis three times per week just to stay alive. What puzzled doctors most was that they didn’t resemble typical dialysis patients, who are older and have long histories of obesity, diabetes, or hypertension. These were otherwise healthy young men. For more than a decade, the plight of these patients has haunted Ricardo Nuila, an internist at Houston’s Ben Taub Hospital. He saw them almost daily, greeting them with the warm smile that lends his dark eyes their inner glow. The smile hid his quiet grief. He feared that these men would die far too early, their kidneys having given out for reasons no physician can ascertain. Nuila wasn’t alone in his concern. Doctors at Harris County’s other safety-net hospitals reported seeing much the same. But Nuila got a hint about what might be happening while visiting El Salvador, where he’d spent his childhood summers with family. The country was dealing with a deadly epidemic that affects vast numbers of sugarcane cutters on plantations throughout Central America. It’s known as chronic kidney disease of unknown origin—CKDu—or as Mesoamerican nephropathy. Kidney diseases are among the leading causes of death in El Salvador, where dialysis is not widely available. Researchers had found signs of CKDu outside Central America, including in Sri Lanka, India, and Nepal. But it had never been documented in the United States. If the men arriving at Ben Taub were experiencing CKDu, Nuila worried that he might have been witnessing the first wave of a coming tsunami of kidney failure and death—with Texas at the center. **Epidemiologists disagree on exactly what causes CKDu, although studies have consistently identified physical labor in extreme heat as a contributor. A 2019 article in The New England Journal of Medicine called it “a sentinel disease in the era of climate change.” But studies of CKDu have been especially challenging to execute because the disease primarily affects marginalized populations.** The possibility that CKDu had arrived in Texas was unnerving, but there was one potential upside. It could offer an opportunity to harness the cutting-edge medical research available in Houston to solve the mystery of CKDu’s origins. That might prevent young men from being debilitated in the prime of their lives. \[...\] No one could explain what was going on. Researchers argued endlessly about potential causes. Some endemic diseases, such as hantavirus and a bacterial infection called leptospirosis, were known to cause kidney failure. Other possible contributors were the dousing of crops with toxic pesticides and the burning of sugarcane before each harvest, which left the ground covered in lung- and kidney-clogging ash. Plus, the local water wasn’t always safe to drink, and workers consumed ibuprofen and other organ-damaging painkillers. Then there was the heat. The sun pounds down relentlessly on a workforce that performs labor that’s the physical equivalent of running a half-marathon every day. “They’re like Olympic athletes, and they subsist on dirty water and crappy food,” says Jason Glaser, founder and CEO of La Isla Network, an organization based in Washington, D.C., that advocates for the protection of workers from heat-related illnesses. In 2014, facing media scrutiny and watching their workforce die, sugar-plantation owners in Nicaragua asked Kristy Murray, then an epidemiologist at the National School of Tropical Medicine, at Baylor College of Medicine, in Houston, for help. Murray’s expertise in the neglected diseases of Central America made her the perfect choice. Murray, who had been Fischer’s adviser, tapped her to lead the effort. That was how several months later, Fischer, with a newly minted doctorate, found herself in the middle of a plantation in Nicaragua. She’d brought the biosafety gear to provide protection if the culprit turned out to be some infectious virus or bacterium or fungus—hypotheses that she initially thought would explain CKDu. She trapped, euthanized, and dissected hundreds of rodents in and around the sugarcane fields in the hope that they would hold the key. \[...\] Keep reading: [Link ](https://www.texasmonthly.com/news-politics/ckdu-kidney-disease-immigration/)

A Mysterious Kidney Disease Has Arrived in Texas. Immigration Enforcement Has Made It Harder to Combat. Some staggered through the hospital’s doors, arriving at all hours of day and night. Others were wheeled in on gurneys, their bodies having given out before they could reach the emergency department. Many had collapsed at work—while painting houses, stapling shingles, or paving roads. All had been born in Mexico or Central America, and most complained of a crushing fatigue they could no longer ignore. Routine blood analyses revealed the cause: kidney failure. They would need dialysis three times per week just to stay alive. What puzzled doctors most was that they didn’t resemble typical dialysis patients, who are older and have long histories of obesity, diabetes, or hypertension. These were otherwise healthy young men. For more than a decade, the plight of these patients has haunted Ricardo Nuila, an internist at Houston’s Ben Taub Hospital. He saw them almost daily, greeting them with the warm smile that lends his dark eyes their inner glow. The smile hid his quiet grief. He feared that these men would die far too early, their kidneys having given out for reasons no physician can ascertain. Nuila wasn’t alone in his concern. Doctors at Harris County’s other safety-net hospitals reported seeing much the same. But Nuila got a hint about what might be happening while visiting El Salvador, where he’d spent his childhood summers with family. The country was dealing with a deadly epidemic that affects vast numbers of sugarcane cutters on plantations throughout Central America. It’s known as chronic kidney disease of unknown origin—CKDu—or as Mesoamerican nephropathy. Kidney diseases are among the leading causes of death in El Salvador, where dialysis is not widely available. Researchers had found signs of CKDu outside Central America, including in Sri Lanka, India, and Nepal. But it had never been documented in the United States. If the men arriving at Ben Taub were experiencing CKDu, Nuila worried that he might have been witnessing the first wave of a coming tsunami of kidney failure and death—with Texas at the center. **Epidemiologists disagree on exactly what causes CKDu, although studies have consistently identified physical labor in extreme heat as a contributor. A 2019 article in The New England Journal of Medicine called it “a sentinel disease in the era of climate change.” But studies of CKDu have been especially challenging to execute because the disease primarily affects marginalized populations.** The possibility that CKDu had arrived in Texas was unnerving, but there was one potential upside. It could offer an opportunity to harness the cutting-edge medical research available in Houston to solve the mystery of CKDu’s origins. That might prevent young men from being debilitated in the prime of their lives. \[...\] No one could explain what was going on. Researchers argued endlessly about potential causes. Some endemic diseases, such as hantavirus and a bacterial infection called leptospirosis, were known to cause kidney failure. Other possible contributors were the dousing of crops with toxic pesticides and the burning of sugarcane before each harvest, which left the ground covered in lung- and kidney-clogging ash. Plus, the local water wasn’t always safe to drink, and workers consumed ibuprofen and other organ-damaging painkillers. Then there was the heat. The sun pounds down relentlessly on a workforce that performs labor that’s the physical equivalent of running a half-marathon every day. “They’re like Olympic athletes, and they subsist on dirty water and crappy food,” says Jason Glaser, founder and CEO of La Isla Network, an organization based in Washington, D.C., that advocates for the protection of workers from heat-related illnesses. In 2014, facing media scrutiny and watching their workforce die, sugar-plantation owners in Nicaragua asked Kristy Murray, then an epidemiologist at the National School of Tropical Medicine, at Baylor College of Medicine, in Houston, for help. Murray’s expertise in the neglected diseases of Central America made her the perfect choice. Murray, who had been Fischer’s adviser, tapped her to lead the effort. That was how several months later, Fischer, with a newly minted doctorate, found herself in the middle of a plantation in Nicaragua. She’d brought the biosafety gear to provide protection if the culprit turned out to be some infectious virus or bacterium or fungus—hypotheses that she initially thought would explain CKDu. She trapped, euthanized, and dissected hundreds of rodents in and around the sugarcane fields in the hope that they would hold the key. \[...\] Keep reading: [Link ](https://www.texasmonthly.com/news-politics/ckdu-kidney-disease-immigration/)