Background and objectives A kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis. Design, setting, participants, & measurements We designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy. Results From 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics-age, urine dipstick for protein, and serum albumin-could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease. Conclusions A primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.

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Stillbirths is one of major health issues in Sri Lankan context. This study aimed to explore the distribution of externally identifiable congenital anomalies according to their sex and the period of gestation and to estimate risk of stillbirth with or without congenital anomalies to be born pre-term or term. Sample size was 246. Due to extreme prematurity and maceration, 05 fetuses were excluded. Of 241 stillbirths, 36 (14.9%) had congenital anomalies and majority were females (n=23, 9.5%). The mean period of gestation was 31 weeks (SD=5.3). 12.5% with congenital anomalies were pre-term. 95% confidence interval (0.261-1.170) of risk estimate revealed that there is no statistically significant association between fetal sex and having congenital anomalies. Risk to be preterm stillbirth for the fetuses with congenital anomalies was 2.447 times (OR = 2.447) greater than the non-anomulous. Females were at high risk to acquire congenital anomalies. Congenital anomalies caused preterm stillbirths.

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