The hormone erythropoietin (EPO) is synthesised by interstitial fibroblasts in the kidney and promotes erythropoiesis.16 17 In response to tubular stress, injury and inflammation, EPO-producing cells may transform into myofibroblasts promoting progression of interstitial fibrosis and expressing less EPO, possibly leading to anaemia,16 17 which is a common finding in Mesoamerican sugarcane workers with recent SCr increase.8 11 18. The gene discussed is EPO; the disease is anemia.