In reply to: "Should we consider renaming 'Mesoamerican Nephropathy as Nephropathy of Unknown Cause in Agricultural Labourers (NUCAL)?"

We, from the Consortium on the Epidemic of Nephropathy in Central America and Mexico (CENCAM), read with interest Drs Subramanian and Javaid's letter,1 regarding Mesoamerican Nephropathy (MeN), a name assigned to a type of chronic kidney disease (CKD) not related to classic risk factors and also referred to as CKD of unknown (CKDu) or non-traditional causes. MeN is highly prevalent in Central America and a major health problem.2

We agree with the authors that it is important to focus attention on the occupational component of this disease, and therefore on its preventable nature. Nevertheless, we consider it premature and inappropriate to rename MeN and other regional nephropathies as Nephropathy of Unknown Cause in Agricultural Labourers (NUCAL). First, this would imply that there is enough evidence to confirm that what is being described in Mesoamerica and other CKDu epidemics in developing nations (ie, Sri Lanka, India,...

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