1. The controversy presented in this article is that most men in Chichigalpa, Nicaragua that are literally working themselves to death in the sugar cane fields end up severely sick or sometimes dead because of this Chronic Kidney Disease from unknown causes. 2. This issue takes place in Chichigalpa, Nicaragua. These men, who work hard labor in hot temperatures every day pick sugar cane from the fields as their job but are extremely susceptible to death or getting severely sick from this disease. Chronic kidney disease from unnatural causes, also known as CKDu, are caused from working too hard in hot temperatures, particularly among industrial agricultural workers such as those working in sugarcane production. CKDu often affects young men, many under the age of 30 while regular Chronic Kidney Disease (CKD) is generally diagnosed in older patients. Before the men can start working, they take a blood or urine test to measure the kidney function in order to determine if the person is able to work out in the fields. The sugar companies certainly don't appear to be encouraging diagnosis. Reports from Nicaragua suggest that workers who test positive are simply fired. 3. Scientists first became aware that there was a problem in the early 2000s, and yet this is thought to have been going on as long ago as the 1970s. It remained unknown partly because in the deep countryside there are no kidney specialists to identify such an unusual condition. Out there, the poor simply die. CKDu is usually called a “silent killer” that has been preying on Central America for at least 20 years, killing impoverished land workers. It is becoming ever more deadly. Between 2005 and 2009, incidents in El Salvador rose by 26%. By 2011 the chronic kidney disease (CKD) that is killing had become the country's second-biggest killer of men in Latin America. In the past 20 years, at least 20,000 people have died from it. About 46% of men in Chichigalpa, Nicaragua, one