Ankara Med J. 2020; 20(3): 761-772 | DOI: 10.5505/amj.2020.37029

Pesticide Exposure and Chronic Kidney Disease Among Agricultural Workers

Nezaket Özpolat Çakar¹, Dilek Kutsal², Sibel Kiran^3
1Hacettepe University, Institute of Health Sciences, Student in Occupatonal Health PhD Programme, Ankara, Mersin Health Directorate, Mersin
²Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Nephrology, Istanbul
³Hacettepe University, Institute of Public Health, Department of Occupational Health and Safety, Ankara

Pesticides are chemicals that are widely used in many areas of life, especially in agriculture. There is always a risk of toxicity if agricultural workers do not have sufficient knowledge and experience about the use of pesticides and preventive measures are inadequate. In the literature, there are references to acute toxic effects of pesticides as well as their chronic effects, such as cancer, diabetes, high blood pressure, cardiovascular diseases, and neurological disorders. In addition to these chronic effects, early-onset and rapidly developing chronic kidney disease has been reported in agricultural workers over the past two decades, which progresses to end-stage renal disease. The renal biopsies that have been performed on these patients showed chronic tubulointerstitial changes. This disease, observed in agricultural workers, is either referred to as “Chronic Kidney Disease of unknown cause (CKDu)” or "Mesoamerican nephropathy," in reference to the region where it was first identified. It is argued that heat stress and pesticides play an active role in its etiology. From this point of view, countries with high pesticide use that are affected by climate change are referred to as "countries in the risk group". The use of pesticides is increasing in Turkey, which is also adversely affected by climate change caused by global warming. Greenhouse workers in particular are more exposed to heat stress and pesticides, since they work in a closed environment. Therefore, preventive measures and awareness are particularly important in these regions, as the disease progresses without symptoms.

Keywords: occupational health, occupational disease, agricultural workers, chronic kidney disease, pesticides

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Tarým Çalýþanlarýnda Pestisit Maruz Kalýmý ve Kronik Böbrek Hastalýðý

Nezaket Özpolat Çakar¹, Dilek Kutsal², Sibel Kiran^3
1Hacettepe Üniversitesi, Saðlýk Bilimleri Enstitüsü Ýþ Saðlýðý Doktora Programý, Ankara, Mersin Saðlýk Müdürlüðü, Mersin
²Dr. Siyami Ersek Göðüs Kalp ve Damar Cerrahisi Eðitim ve Araþtýrma Hastanesi, Nefroloji, Ýstanbul
³Hacettepe Üniversitesi, Halk Saðlýðý Enstitüsü Ýþ Saðlýðý ve Güvenliði Ana Bilim Dalý, Ankara

Pestisitler yaþamýn pek çok alanýnda yaygýn kullanýlan kimyasal maddelerdir. Tarým çalýþanlarýnýn pestisit kullanýmý konusunda yeterli bilgi ve donaným yoksa ve koruyucu önleyici yaklaþýmlar yetersizse toksisite riski söz konusudur. Literatürde pestisitlerin akut toksik etkilerinin yaný sýra, kanser, diyabet, hipertansiyon, kardiyovasküler hastalýklar, nörolojik hastalýklar gibi kronik etkilerden de bahsedilmektedir. Bu kronik etkilere ek olarak son yirmi yýldýr; tarým çalýþanlarýnda görülen, son dönem böbrek hastalýðýna ilerleyen, erken baþlangýçlý ve hýzlý geliþen kronik bir böbrek hastalýðý da bildirilmektedir. Bu hastalarda yapýlan çalýþmalar da böbrek biyopsilerinde kronik tubulointerstisyel deðiþiklikler gözlenmiþtir. Tarým çalýþanlarýnda görülen bu hastalýk, etiyolojisi bilinmeyen kronik böbrek hastalýðý anlamýnda “Chronic Kidney Disease of unknown cause (CKDu)” veya ilk tanýmlandýðý bölgeye atfen; “Mesoamerikan nefropatisi” olarak adlandýrýlmýþtýr. Etiyolojisinde ýsý stresi ve pestisit kullanýmýnýn etkin rol oynadýðý tartýþýlmaktadýr. Bu açýdan açýdan deðerlendirildiðinde pestisit kullanýmý yüksek olan ve iklim deðiþikliðinden etkilenen ülkeler “risk grubundaki ülkeler” olarak tanýmlanmaktadýr. Türkiye de pestisit kullanýmý konusunda artan bir seyir izlemektedir ve küresel ýsýnmanýn neden olduðu iklim deðiþikliklerinden olumsuz etkilenmektedir. Özellikle sera çalýþanlarýnda, çalýþtýklarý ortamýn kapalý olmasý nedeniyle ýsý stresi ve pestisit maruz kalýmý yoðunluðunun artmasý riski artýrmaktadýr. Bundan dolayý söz konusu bölgelerdeki koruyucu-önleyici yaklaþýmlar ve farkýndalýk, bu hastalýðýn belirti vermeden ilerleyici nitelikte olmasý nedeniyle özellikle önem taþýmaktadýr.

Anahtar Kelimeler: iþ saðlýðý, meslek hastalýðý, tarým çalýþanlarý, kronik böbrek hastalýðý, pestisitler

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