Nezaket ÖZPOLAT ÇAKAR, Dilek KUTSAL, Sibel KİRAN

TARIM ÇALIŞANLARINDA PESTİSİT MARUZ KALIMI VE KRONİK BÖBREK HASTALIĞI

Pestisitler yaşamın pek çok alanında yaygın kullanılan kimyasal maddelerdir. Tarım çalışanlarının pestisit kullanımı konusunda yeterli bilgi ve donanım yoksa ve koruyucu önleyici yaklaşımlar yetersizse toksisite riski söz konusudur. Literatürde pestisitlerin akut toksik etkilerinin yanı sıra, kanser, diyabet, hipertansiyon, kardiyovasküler hastalıklar, nörolojik hastalıklar gibi kronik etkilerden de bahsedilmektedir. Bu kronik etkilere ek olarak son yirmi yıldır; tarım çalışanlarında görülen, son dönem böbrek hastalığına ilerleyen, erken başlangıçlı ve hızlı gelişen kronik bir böbrek hastalığı da bildirilmektedir. Bu hastalarda yapılan çalışmalarda böbrek biyopsilerinde kronik tubulointerstisyel değişiklikler gözlenmiştir. Tarım çalışanlarında görülen bu hastalık, etiyolojisi bilinmeyen kronik böbrek hastalığı anlamında “Chronic Kidney Disease of unknown cause (CKDu)” veya ilk tanımlandığı bölgeye atfen; “Mesoamerikan nefropatisi” olarak adlandırılmıştır. Etiyolojisinde ısı stresi ve pestisit kullanımının etkin rol oynadığı tartışılmaktadır. Bu açıdan değerlendirildiğinde pestisit kullanımı yüksek olan ve iklim değişikliğinden etkilenen ülkeler “risk grubundaki ülkeler” olarak tanımlanmaktadır. Türkiye de pestisit kullanımı konusunda artan bir seyir izlemektedir ve küresel ısınmanın neden olduğu iklim değişikliklerinden olumsuz etkilenmektedir. Özellikle sera çalışanlarında, çalıştıkları ortamın kapalı olması nedeniyle ısı stresi ve pestisit maruz kalımı yoğunluğunun artması riski artırmaktadır. Bundan dolayı söz konusu bölgelerdeki koruyucu-önleyici yaklaşımlar ve farkındalık, bu hastalığın belirti vermeden ilerleyici nitelikte olması nedeniyle özellikle önem taşımaktadır

PESTICIDE EXPOSURE AND CHRONIC KIDNEY DISEASE AMONG AGRICULTURAL WORKERS

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.

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