Chronic kidney disease (CKD) of unknown etiology (CKDu) is a serious health issue in Sri Lanka. One-to-one age and sex-matched two sample comparative study was carried out in the Medawachchiya divisional secretariat area of the North Central Province (NCP) of Sri Lanka, by randomly selecting 100 CKDu patients and 100 age and sex-matched subjects from non-CKDu affected families from the same area. An interviewer-administered questionnaire was used for the collection of data pertaining to occupation, medical history and lifestyle. Data were analyzed using a conditional linear logistic model. Working for >6 h in the field per day, exposure to sun, drinking water only from well, consumption of <3 L of water per day, and having a history of malaria were found to be having significant (P < 0.05) likelihood toward the development of CKDu. Treatment of water prior to consumption had a significant protective effect against CKDu. Dehydration, history of malaria and drinking untreated well water from are likely contribute to the development of CKD of unknown etiology among the inhabitants of NCP, Sri Lanka.

The development of the cutaneous capillaries has been studied in 40 infants aged 1 day to 17 weeks. At birth there is a disorderly capillary network. There is a gradual development to an orderly subpapiliary plexus and papillary loops by I4th-17th week of life. In areas of creases this development is delayed, while in the palms, soles and nail folds there is an early development of capillary loops.An attempt has been made to correlate this development with certain dynamic physiological processes during the neonatal period as well as with exposure to the cold environment. These physiological processes are:(a) increase in skin surface area (b) increased blood viscosity related to (i) increased haematocrit (ii) decreased oxygen tension (iii) low blood pressure (iv) increased transudation of fluid from blood vessels (v) decreased sedimentation rate (vi) decreased red cell flexibility.IN addition to eontinuation of many of the physiological growth processes started at eoneeption, at birth a whole host of new proeessos are put in motion. The majority of these processes are concerned with the adaptation of the neonate to independent existence as well as with the continued growth and maturation. One sueh proeess is the development of the mieroeireulation in the skin-a development whieh is influeneed, undoubtedly, by many faetors in the body as well as in the environment.The skin oftlie newborn is well endowed with blood vessels. Redness ofthe entire skin at birth is one of the most obvious featnre^. By the end of a week, many areas of the skin have become paler. Observations using eapillary microscopy ha\^e suggested that the capillaries ofthe skin change in morphology during the fii'st few weeks of life (Holland ). These observers studied the nailfolds only. Schwalm (1934) made similar observations on infant skin at sites other than itl the nailfold. With present day apparatus it is mueh easier to observe the hlood supply of the skin in several areas. The following describes observations on the development of blood vessels in the skin anti discttsses the possible correlations with other physiological processes.MATERIALS AND METHODS T7sing oapillary microscopy as described previously 40 healthy full-term infants were studied. Because pigment obscures tho vasculature of tho skin only white subjects were studied. Tbere were 20 females and 20 males Jind their ngea I'anged from I day to 17 weeks. The following areas were examined: cheek, arm, anteinibital, forearm, wrist, palm, leg, ankle, sole and nail folds. Because of tbe difficulty in Immobilizing tbe infants, satisfactory photographic recot'ds were not obtained and therefore more thnii one observer examined each infant and the agreed findings were recorded.

The prevalence of dental caries and dental fluorosis was examined in 380 14-yr-old children living in four geographic areas of Sri Lanka with water F-levels of 0.09-8.0 ppm. A reduction in caries prevalence by 43% was recorded in children consuming 0.6-0.79 ppm F- compared to those in low fluoride areas (< 0.4 ppm). Among those consuming drinking water containing < 1.0 ppm F-, however, 32% of the children had mild forms and 9% severe forms of dental fluorosis (Dean's index). Although other sources of F- may contribute to this effect, the prevalence and severity of dental fluorosis seen in low fluoride areas was confirmed to be high in rural Sri Lanka. Our data are comparable with recent findings from other tropical countries, e.g. Kenya and Senegal, and reaffirm that WHO guidelines for the upper limit of F- in drinking water may be unsuitable for developing countries with a hot, dry climate. Current knowledge now enables us to recommend 0.8 ppm as an appropriate upper limit for F- in drinking water supplies for these populations.

The study provides further evidence that areca nut contributes to the development of OSF in treated animals. The model has the potential to test synergism of areca nut with other carcinogens and any therapeutic interventions.

BackgroundExact mechanism of causation of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is not described to date, despite the identification of possible multiple risk factors. Questions have been raised as to why only some are affected while others remain intact, though they are inhabitants of the same locality.MethodsComparative studies were carried out, assessing urinary β2 microglobulin (β2m) and the dietary patterns of CKDu patients and age sex matched non-CKDu subjects. Urinary β2m levels of spot urine samples were analyzed using the Enzyme-linked Immunosorbent assay (ELISA) and dietary patterns were studied using twenty four hour dietary recalls and frequency consumption of foods of animal origin performed on three occasions at six months intervals within a period of one and half years.ResultsThe mean urinary β2m level of CKDu patients from Medawachchiya was significantly (p < 0.05) higher when compared with that of the non-CKDu subjects. The mean urinary β2m level of the non-CKDu subjects was within the reference limits for spot urine samples (0 – 0.3 μg/mL). White raw rice was the staple diet of both CKDu patients and non-CKDu subjects and the level of consumption was almost the same. The consumption of fresh water fish products of CKDu patients under high (14, 14%), moderate (36, 36%), low (26, 26%) and less (20, 20%) categories did not show significant variations (p > 0.05) compared to non-CKDu subjects.ConclusionsStaple food in diet and the consumption pattern of CKDu patients from Medawachchiya were similar to that of non-CKDu subjects from the same area despite their urinary β2m concentration being significantly higher.