{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:02:18Z","timestamp":1753891338243,"version":"3.41.2"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T00:00:00Z","timestamp":1741132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic kidney disease of unknown etiology (CKDu) is a form of chronic kidney disease commonly found in certain rural populations globally. This condition is characterized by chronic tubulointerstitial nephropathy, yet it lacks specific signature lesions and is believed to have a multifactorial etiology, often associated with environmental toxins. Karyomegalic Interstitial Nephritis (KIN), although a rare form of chronic interstitial nephropathy leading to end-stage kidney disease, is not classified under CKDu.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>In this case report, we explore the diagnostic journey of a 40-year-old male farmer from Guatemala. He presented with headache, fever, and facial pain, but laboratory tests revealed significant kidney impairment and liver dysfunction. The pivotal point in his diagnostic workup was a kidney biopsy, which showed severe chronic tubulointerstitial scarring and enlarged, hyperchromatic nuclei in the tubular epithelial cells, confirming KIN. This diagnosis marked a departure from the initial suspicion of Mesoamerican Nephropathy (MEN).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case underscores the critical need for a comprehensive evaluation in atypical presentations of chronic kidney disease, particularly emphasizing the importance of being vigilant for KIN in areas where MEN is commonly diagnosed.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1465783","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T07:12:41Z","timestamp":1741158761000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The unexpected diagnosis of karyomegalic interstitial nephritis in a presumed case of Mesoamerican Nephropathy: a case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Lawrence","family":"Kwon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Griffiths","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lanny T.","family":"DiFranza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1056\/nejmra1813869","article-title":"Chronic kidney disease of unknown cause in agricultural communities","volume":"380","author":"Johnson","year":"2019","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41572-018-0022-7","article-title":"Hepatorenal syndrome","volume":"4","author":"Gin\u00e8s","year":"2018","journal-title":"Nat Rev Dis Primers"},{"key":"ref3","first-page":"11","article-title":"Hepatorenal syndrome","volume":"28","author":"Ng","year":"2007","journal-title":"Clin Biochem Rev"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e20212","DOI":"10.7759\/cureus.20212","article-title":"A comprehensive review study on glomerulonephritis associated with post-streptococcal infection","volume":"13","author":"Alhamoud","year":"2021","journal-title":"Cureus"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1016\/S0016-5085(19)33249-4","article-title":"Significance of serum complement levels in chronic liver disease","volume":"63","author":"Finlayson","year":"1972","journal-title":"Gastroenterology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1038\/ng.2347","article-title":"FAN1 mutations cause karyomegalic interstitial nephritis, linking chronic kidney failure to defective DNA damage repair","volume":"44","author":"Zhou","year":"2012","journal-title":"Nat Genet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"349","DOI":"10.5414\/cnp65349","article-title":"Karyomegalic interstitial nephritis: report of 3 new cases and review of the literature","volume":"65","author":"Monga","year":"2006","journal-title":"Clin Nephrol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1002\/dc.20603","article-title":"Karyomegalic interstitial nephritis: a pitfall in urine cytology","volume":"35","author":"Palmer","year":"2007","journal-title":"Diagn Cytopathol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1016\/j.kint.2022.07.003","article-title":"Persistent DNA damage underlies tubular cell polyploidization and progression to chronic kidney disease in kidneys deficient in the DNA repair protein FAN1","volume":"102","author":"Airik","year":"2022","journal-title":"Kidney Int"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/s0272-6386(96)90047-5","article-title":"Karyomegalic interstitial nephritis","volume":"27","author":"Godin","year":"1996","journal-title":"Am J Kidney Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1681\/ASN.20223311S180a","article-title":"Acute interstitial nephritis secondary to Brentuximab","volume":"33","author":"Hammad","year":"2022","journal-title":"J Am Soc Nephrol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1681\/ASN.20223311S1612a","article-title":"Enfortumab-Vedotin as a cause of severe acute interstitial nephritis","volume":"33","author":"Khan","year":"2022","journal-title":"J Am Soc Nephrol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1681\/ASN.20223311S1378d","article-title":"Cellular senescence is associated with CKD progression in childhood Cancer patients with Karyomegalic interstitial nephropathy","volume":"33","author":"Keijzer-Veen","year":"2022","journal-title":"J Am Soc Nephrol"},{"volume-title":"Gabrijela Kocjan","year":"2010","author":"Gray","key":"ref14"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1002\/jcla.21978","article-title":"Bright field microscopy to detect decoy cells due to BK virus infection in the fresh and unstained urine sediment in kidney allograft recipients","volume":"30","author":"Poloni","year":"2016","journal-title":"J Clin Lab Anal"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1053\/j.ajkd.2013.05.019","article-title":"Clinical and pathological characterization of Mesoamerican nephropathy: a new kidney disease in Central America","volume":"62","author":"Wijkstr\u00f6m","year":"2013","journal-title":"Am J Kidney Dis"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1186\/s12882-023-03185-3","article-title":"Karyomegalic interstitial nephritis as a rare cause of kidney graft dysfunction: case report and review of literature","volume":"24","author":"Moustafa","year":"2023","journal-title":"BMC Nephrol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1465783\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T07:12:43Z","timestamp":1741158763000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1465783\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,5]]},"references-count":17,"alternative-id":["10.3389\/fmed.2025.1465783"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1465783","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2025,3,5]]},"article-number":"1465783"}}