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Some staggered through the hospital's doors, arriving at all hours of day and night. Others were wheeled in on gurneys, their bodies having given out before they could reach the emergency department. Many had collapsed at work—while painting houses, stapling shingles, or paving roads. All had been born in Mexico or Central America, and most complained of a crushing fatigue they could no longer ignore.

Routine blood analyses revealed the cause: kidney failure. They would need dialysis three times per week just to stay alive. What puzzled doctors most was that they didn't resemble typical dialysis patients, who are older and have long histories of obesity, diabetes, or hypertension. These were otherwise healthy young men.

For more than a decade, the plight of these patients has haunted Ricardo Nuila, an internist at Houston's Ben Taub Hospital. He saw them almost daily, greeting them with the warm smile that lends his dark eyes their inner glow. The smile hid his quiet grief. He feared that these men would die far too early, their kidneys having given out for reasons no physician can ascertain.