Retrospective analysis of renal histology in asymptomatic patients with probable chronic kidney disease of unknown aetiology in Sri Lanka

Wijetunge, Sulochana; Ratnatunga, Neelakanthi; Abeysekera, D T; Wazil, Abdul; Selvarajah, Mathu; Ratnatunga, Champa N.

doi:10.4038/cmj.v58i4.6304

Cited by 36 publications

(50 citation statements)

References 18 publications

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“…The earliest pathological manifestation was interstitial inflammation and interstitial fibrosis, whereas tubular atrophy and glomerulosclerosis were seen in later stages. 23 …”

Section: Methodsmentioning

confidence: 99%

Epidemiology of Chronic Kidney Disease, With Special Emphasis on Chronic Kidney Disease of Uncertain Etiology, in the North Central Region of Sri Lanka

Jayasekara

Dissanayake

Sivakanesan

et al. 2015

Journal of Epidemiology

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BackgroundThe aim of the study was to identify the epidemiology of chronic kidney disease of uncertain etiology in Sri Lanka.MethodsA cross-sectional study was carried out by analyzing health statistics, and three cohort studies were conducted (n = 15 630, 3996, and 2809) to analyze the demographic information, age-specific prevalence, etiology, and stage of presentation. We screened 7604 individuals for chronic kidney disease of uncertain etiology.ResultsThe results showed that the male:female ratio was 2.4:1, the mean age of patients was 54.7 ± 8 years, 92% of the patients were farmers, and 93% consumed water from shallow dug wells. Familial occurrence was common (36%). The prevalence of chronic kidney disease in different age groups was 3% in those aged 30–40 years; 7% in those aged 41–50 years, 20% in those aged 51–60 years, and 29% in those older than 60 years. Chronic kidney disease of uncertain etiology was diagnosed in 70.2% of patients, while 15.7% and 9.6% were due to hypertension and diabetic mellitus, respectively. The majority of patients were stage 4 (40%) at first presentation, while 31.8% were stage 3 and 24.5% were stage 5. Stage 1 and 2 presentation accounted for only 3.4%.ConclusionsLow prevalence of CKDU was noticed (1.5%) among those who consumed water from natural springs. Prevalence was highest among males, rice farming communities, and those presenting at later disease stages.

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“…The earliest pathological manifestation was interstitial inflammation and interstitial fibrosis, whereas tubular atrophy and glomerulosclerosis were seen in later stages. 23 …”

Section: Methodsmentioning

confidence: 99%

Epidemiology of Chronic Kidney Disease, With Special Emphasis on Chronic Kidney Disease of Uncertain Etiology, in the North Central Region of Sri Lanka

Jayasekara

Dissanayake

Sivakanesan

et al. 2015

Journal of Epidemiology

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“…Tubulointerstitial disease is a prominent feature in subjects with suspected CKDu. 15,16,20,22,23 A recent study in asymptomatic CKDu patients with proteinuria showed that the majority of subjects had varying degrees of interstitial fibrosis, interstitial inflammation, glomerulosclerosis, and tubular atrophy. 18 In this study, interstitial fibrosis in more than 5% of cortical area was seen in 93% of study subjects.…”

Section: Histopathological Findings In Ckdumentioning

confidence: 99%

“…18 Nonetheless, it is postulated that interstitial inflammation may play a role in the progression of the disease. 20,23 Another study conducted between 2008 and 2009 demonstrated glomerular changes, included global sclerosis (37.1%), ischemic-type obsolescence, wrinkled and collapsed glomerular tufts (17.6%), and glomerular enlargement (36%). 18 Focal segmental glomerulosclerosis was uncommon (3.6%).…”

Section: Histopathological Findings In Ckdumentioning

confidence: 99%

Chronic kidney disease of unknown etiology in Sri Lanka

Rajapakse

Shivanthan²,

Selvarajah

2016

International Journal of Occupational and Environmental Health

111

109

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Evidence to date suggests that the disease is related to one or more environmental agents, however pinpointing a definite cause for CKDu is challenging. It is plausible that CKDu is multifactorial. No specific guidelines or recommendations exist for treatment of CKDu, and standard management protocols for CKD apply. Changes in agricultural practices, provision of safe drinking water, and occupational safety precautions are recommended by the World Health Organization.

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“…Because the cause remains unknown, the disease is also called "CKD of unknown origin" (CKDu) [4][5][6]. In disease-affected that of CKDmfo [20][21][22][23]. CKDmfo is a tubular disease and thus, protein urea is a late manifestation.…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting the Environmentally Induced, Chronic Kidney Disease of Unknown Aetiology in Dry Zonal Regions in Tropical Countries—Novel Findings

Wimalawansa¹,

Dissanayake

2019

Environments

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A new form of chronic tubulointerstitial kidney disease (CKD) not related to diabetes or hypertension appeared during the past four decades in several peri-equatorial and predominantly agricultural countries. Commonalities include underground stagnation of drinking water with prolonged contact with rocks, harsh climatic conditions with protracted dry seasons, and rampant poverty and malnutrition. In general, the cause is unknown, and the disease is therefore named CKD of unknown aetiology (CKDu). Since it is likely caused by a combination of factors, a better term would be CKD of multifactorial origin (CKDmfo). Middle-aged malnourished men with more than 10 years of exposure to environmental hazards are the most vulnerable. Over 30 factors have been proposed as causative, including agrochemicals and heavy metals, but none has been properly tested nor proven as causative, and unlikely to be the cause of CKDmfo/CKDu. Conditions such as, having favourable climatic patterns, adequate hydration, and less poverty and malnutrition seem to prevent the disease. With the right in vivo conditions, chemical species such as calcium, phosphate, oxalate, and fluoride form intra-renal nanomineral particles initiating the CKDmfo. This article examines the key potential chemical components causing CKDmfo together with the risk factors and vulnerabilities predisposing individuals to this disease. Research findings suggest that in addition to drinking water from stagnant sources that contain high ionic components, more than 10 years of exposure to environmental nephrotoxins and micronutrient malnutrition are needed to contract this fatal disease.

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Retrospective analysis of renal histology in asymptomatic patients with probable chronic kidney disease of unknown aetiology in Sri Lanka

Cited by 36 publications

References 18 publications

Epidemiology of Chronic Kidney Disease, With Special Emphasis on Chronic Kidney Disease of Uncertain Etiology, in the North Central Region of Sri Lanka

Epidemiology of Chronic Kidney Disease, With Special Emphasis on Chronic Kidney Disease of Uncertain Etiology, in the North Central Region of Sri Lanka

Chronic kidney disease of unknown etiology in Sri Lanka

Factors Affecting the Environmentally Induced, Chronic Kidney Disease of Unknown Aetiology in Dry Zonal Regions in Tropical Countries—Novel Findings

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