Could Consumption of Trace Element–Contaminated Rice Be a Risk Factor for Acute Interstitial Nephritis with Uncertain Etiology in the Dry Zone of Sri Lanka?

Premarathne, Shakila; Chandrajith, Rohana; Nanayakkara, Nishantha; Gamage, Chandika D.; Ratnatunga, Neelakanthi; Wijetunge, Sulochana; Badurdeen, Zeid; Guruge, Shashika; Elladeniya, N; Madushan, K P S; Samarasiri, K O C U; Hewavitharane, Pasan; Herath, Dulanjali; Senarathne, Sachintha

doi:10.1007/s12011-021-02880-2

Cited by 4 publications

(5 citation statements)

References 39 publications

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“…Age-, sex-, and occupation-matched endemic healthy controls (ECs) were enrolled from Wilgamuwa, and the non-endemic healthy controls (NECs) were from Maturata (7.0784° N, 80.8032° E), another farming area in Sri Lanka. The inclusion criteria of subjects, determination of disease activity index (AI), and chronicity index (CI) were described elsewhere in detail [ 2 ]. 3 mL of blood samples were collected from each patient at the time of the biopsy and kept for 20 min, and the centrifuges were under 3,000 rpm for 3 min to obtain the serum.…”

Section: Methodsmentioning

confidence: 99%

“…Diverse risk factors, both environmental and behavioral, such as contaminated drinking water, illicit alcohol consumption, smoking, betel chewing, family history, snake bites, and frequent usage of medication were proposed for the etiology of CKDu. In addition, frequent use of agrochemicals, zoonotic diseases, and the consumption of heavy metal-contaminated foods or water were also suggested [ 2 ]. Rodent-borne viral infections, Leptospira and Hanta, are common in agricultural communities and have been hypothesized as possible associates with CKDu [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…CKDu is first described as an asymptomatic disease, demonstrating predominant chronic interstitial changes in renal biopsies. In CKDu regions, an increasing number of cases of acute interstitial nephritis without any known reason (AINu) were reported [ 2 ]. Subsequently, an acute symptomatic form of the same illness has been described in both Sri Lanka and Nicaragua.…”

Section: Introductionmentioning

confidence: 99%

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Leptospirosis: A Potential Culprit for Chronic Kidney Disease of Uncertain Etiology

Premarathne

Gamage

Chandrajith

et al. 2023

Nephron

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Purpose: Chronic kidney disease of uncertain etiology (CKDu) is an environmental nephropathy in which the etiological factors are yet uncertain. Leptospirosis, a spirochetal infection that is common among agricultural communities, has been identified as a potential etiology for CKDu beyond environmental nephropathy. Although CKDu is a chronic kidney disease, in endemic regions, an increasing number of cases are reported with features suggestive of acute interstitial nephritis without any known reason (AINu), with or without background CKD. The study hypothesizes that exposure to pathogenic leptospires is one of the causative factors for the occurrence of AINu. Method: This study was carried out using 59 clinically diagnosed AINu patients, 72 healthy controls from CKDu endemic region (endemic controls [ECs]), and 71 healthy controls from CKDu non-endemic region (non-endemic controls [NECs]). Results: The seroprevalence of 18.6, 6.9, and 7.0% was observed in the AIN (or AINu), EC, and NEC groups, respectively, from the rapid IgM test. Among 19 serovars tested, the highest seroprevalence was observed at 72.9, 38.9, and 21.1% in the AIN (AINu), EC, and NEC groups, respectively, by microscopic agglutination test (MAT), particularly for serovar Leptospira santarosai serovar Shermani. This emphasizes the presence of infection in AINu patients, and this also suggests that Leptospira exposure might play an important role in AINu. Conclusion: These data suggest that exposure to Leptospira infection could be one of the possible causative factors for the occurrence of AINu, which may lead to CKDu in Sri Lanka.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Leptospirosis: A Potential Culprit for Chronic Kidney Disease of Uncertain Etiology

Premarathne

Gamage

Chandrajith

et al. 2023

Nephron

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“…CKDu in India and Thailand also is associated with agrochemical use and heavy metal exposure [7 ▪ ,13]. In India, lead, fluoride, and chromium have been identified variably in blood or urine samples of CKDu patients [7 ▪ ,33]. Groundwater silica levels are up to eight-fold higher in endemic vs. nonendemic regions reaching 12 times higher than recommended levels [7 ▪ ,36].…”

Section: Pathogenesismentioning

confidence: 99%

“…Elevated lead levels have been reported in CKDu vs. control biological samples in areas with rice and vegetable lead contamination [32]. However, other studies have shown rice with acceptable levels of lead, cadmium, and arsenic consumed by CKDu patients, suggesting this is not a primary disease mechanism [33]. Heavy metals and/or trace elements can contaminate agrochemicals resulting in simultaneous nephrotoxin exposures [14].…”

Section: Wwwco-nephrolhypertenscommentioning

confidence: 99%

Chronic kidney disease with unknown cause across the global spectrum

Nast

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewIn the 1990s, a type of chronic kidney disease with unknown cause (CKDu) was identified in Central America and Sri Lanka. Patients lacked hypertension, diabetes, glomerulonephritis, or other usual causes of kidney failure. Affected patients are predominantly male agricultural workers aged 20--60 years, living in economically disadvantaged areas with poor access to medical care. Patients typically present late and progress to end-stage kidney disease within 5 years, resulting in social and economic hardship for families, regions, and countries. This review covers the current state of knowledge for this disease. Recent findingsThe prevalence of CKDu is increasing in known endemic regions and across the globe, reaching epidemic proportions. There is primary tubulointerstitial injury with secondary glomerular and vascular sclerosis. No definitive etiologic factors have been identified, and these may vary or overlap in different geographic locations. The leading hypotheses include exposure to agrochemicals, heavy metals and trace elements, and kidney injury from dehydration/heat stress. Infections and lifestyle factors may play a role, but are likely not key. Genetic and epigenetic factors are beginning to be explored. SummaryCKDu is a leading cause of premature death in young-to-middle-aged adults in endemic regions and has become a public health crisis. Studies are underway to investigate clinical, exposome, and omics factors, and hopefully will provide insights into pathogenetic mechanisms resulting in biomarker discovery, preventive measures, and therapeutics.

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Hydrogeochemical characterization of groundwater with a focus on Hofmeister ions and water quality status in CKDu endemic and CKDu non‒endemic areas, Sri Lanka

Diyabalanage

Edirisinghe

Guo

et al. 2023

Environmental Pollution

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Could Consumption of Trace Element–Contaminated Rice Be a Risk Factor for Acute Interstitial Nephritis with Uncertain Etiology in the Dry Zone of Sri Lanka?

Cited by 4 publications

References 39 publications

Leptospirosis: A Potential Culprit for Chronic Kidney Disease of Uncertain Etiology

Leptospirosis: A Potential Culprit for Chronic Kidney Disease of Uncertain Etiology

Chronic kidney disease with unknown cause across the global spectrum

Hydrogeochemical characterization of groundwater with a focus on Hofmeister ions and water quality status in CKDu endemic and CKDu non‒endemic areas, Sri Lanka

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