Even as chronic kidney disease (CKD) emerges as a global health problem, resource-constrained nations struggle to address this challenge due to the significant cost of life-sustaining long-term renal replacement therapies.1-4 Recently, investigators in Central America, Southern Asia, and Egypt have reported a form of CKD among poor agricultural working communities not attributable to traditional causes such as diabetes, hypertension, primary glomerular disease, or obstructive nephropathy. Based on the geographic areas of primary reporting, it has been called Central American nephropathy, chronic tubulointerstitial kidney disease of Central America, Mesoamerican nephropathy (MeN), Salvadoran agricultural nephropathy, Sri Lankan agricultural nephropathy, and Udhanam endemic nephropathy (India).