An epidemic of chronic kidney disease of unknown etiology (CKDu) has affected the Pacific Coast of Central America. While it primarily affects sugarcane workers, it also affects manual laborers working in other occupations (e.g., brick makers, miners, fishermen and construction workers)1,2. The disease, called Mesoamerican Nephropathy3, is associated with minimal proteinuria and a slowly progressive course. Histologically it is characterized by evidence of ischemia, chronic tubulointerstitial disease, and variable degrees of focal and global glomerulosclerosis 2.