Hydrogeochemical factors controlling the occurrence of chronic kidney disease of unknown etiology (CKDu)

Shi, Qiutong; Gao, Zhipeng; Guo, Huaming; Zeng, Xianjiang; Vithanage, Meththika

doi:10.1007/s10653-022-01379-6

Cited by 5 publications

(2 citation statements)

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“…Groundwater in endemic vs. nonendemic areas contains higher concentrations of silica (21.0 vs. 30.1 mg/l, P < 0.05) and fluoride (0.45 vs. 0.80 mg/l, P < 0.05), with 25% of fluoride concentrations above the Sri Lanka-recommended level [34]. Co-occurrence of elevated fluoride and silica concentrations was associated with CKDu more often than either alone [34]. However, the absence of fluorosis and presence of high fluoride concentrations in nonendemic areas and countries without CKDu cast doubt on a significant role of fluoride [4].…”

Section: Wwwco-nephrolhypertenscommentioning

confidence: 93%

“…High fluoride levels have been found in black tea and groundwater in CKDu hot spots [6,7 ▪ ]. Groundwater in endemic vs. nonendemic areas contains higher concentrations of silica (21.0 vs. 30.1 mg/l, P < 0.05) and fluoride (0.45 vs. 0.80 mg/l, P < 0.05), with 25% of fluoride concentrations above the Sri Lanka-recommended level [34]. Co-occurrence of elevated fluoride and silica concentrations was associated with CKDu more often than either alone [34].…”

Section: Pathogenesismentioning

confidence: 99%

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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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Section: Wwwco-nephrolhypertenscommentioning

confidence: 93%