Using biopsy samples from various countries, Vervaet et al. demonstrated that most patients with chronic interstitial nephritis in agricultural communities (CINAC) had dysmorphic lysosomes in proximal tubular cells. CINAC (also known as chronic kidney disease of unknown origin, mesoamerican nephropathy) is a progressive chronic kidney injury occurring in agricultural laborers (mostly young men) who works in harsh tropical environment. These abnormal lysosomes were remarkably similar to those found in kidney transplant patients who received calcineurin inhibitors (CNI) for immunosuppression. The authors suggests toxins such as those found in pesticides, herbicides could have CNI properties and induces morphological change in lysosomes of proximal tubular cells.
https://doi.org/10.1016/j.kint.2019.11.009
