Uddanam Nephropathy/Regional Nephropathy in India: Preliminary Findings and a Plea for Further Research

Ganguli, Anirban

doi:10.1053/j.ajkd.2016.04.012

Cited by 57 publications

(53 citation statements)

References 36 publications

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“…However, for more than two decades, various regions of the world have experienced an excess of CKD unrelated to these traditional causes, hereafter referred to as “CKDu” (for CKD of unknown cause), in particular in Central America and Mexico (Mesoamerican nephropathy) [2], the North-Central Province of Sri Lanka (Sri Lanka nephropathy) [3] and in the state of Andhra Pradesh of India (Uddanam endemic nephropathy) [4, 5], and possibly in other countries like Egypt [6], Tunisia and Morocco [7], and Saudi Arabia [8]. …”

Section: Introductionmentioning

confidence: 99%

“…From a clinical viewpoint, the regional nephropathies resemble an interstitial tubular pathology, with patients typically being diagnosed in advanced stages of CKD, without diabetes or hypertension, and with no or low-grade proteinuria [5, 16, 17]. The histology has been presented as predominantly interstitial fibrosis and tubular atrophy in studies from El Salvador [18], Sri Lanka [19–21] and India [5]. However, biopsy studies in El Salvador and Nicaragua show important glomerulosclerosis and ischemia with mild to moderate tubulointerstitial damage [22, 23].…”

Section: Introductionmentioning

confidence: 99%

“…In any case, CKDu is now recognized as a serious public health problem to be addressed with renewed efforts in the coming years in Central America [2, 9, 25], Sri Lanka [24] and India [5]. …”

Section: Introductionmentioning

confidence: 99%

“…In addition, exposures to toxic agrochemicals (pesticides and fertilizers) remain a leading hypothesis in Sri Lanka [24, 38], and pesticides are considered as a likely cause of excess CKD in Egypt, where outbreaks of CKDu in rural areas have been reported [6]. The first CKDu review published from India recommends to investigate, besides silica and heat stress, also pesticides as a potential etiology [5]. …”

Section: Introductionmentioning

confidence: 99%

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Pesticide exposures and chronic kidney disease of unknown etiology: an epidemiologic review

et al. 2017

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The main causes of chronic kidney disease (CKD) globally are diabetes and hypertension but epidemics of chronic kidney disease of unknown etiology (CKDu) occur in Central America, Sri Lanka, India and beyond. Althoug also being observed in women, CKDu concentrates among men in agricultural sectors. Therefore, suspicions fell initially on pesticide exposure, but currently chronic heat stress and dehydration are considered key etiologic factors. Responding to persistent community and scientific concerns about the role of pesticides, we performed a systematic review of epidemiologic studies that addressed associations between any indicator of pesticide exposure and any outcome measure of CKD. Of the 21 analytical studies we identified, seven were categorized as with low, ten with medium and four with relatively high explanation value. Thirteen (62%) studies reported one or more positive associations, but four had a low explanation value and three presented equivocal results. The main limitations of both positive and negative studies were unspecific and unquantified exposure measurement (‘pesticides’), the cross-sectional nature of most studies, confounding and selection bias. The four studies with stronger designs and better exposure assessment (from Sri Lanka, India and USA) all showed exposure-responses or clear associations, but for different pesticides in each study, and three of these studies were conducted in areas without CKDu epidemics. No study investigated interactions between pesticides and other concommittant exposures in agricultural occupations, in particular heat stress and dehydration. In conclusion, existing studies provide scarce evidence for an association between pesticides and regional CKDu epidemics but, given the poor pesticide exposure assessment in the majority, a role of nephrotoxic agrochemicals cannot be conclusively discarded. Future research should procure assessment of lifetime exposures to relevant specific pesticides and enough power to look into interactions with other major risk factors, in particular heat stress.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-017-0254-0) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pesticide exposures and chronic kidney disease of unknown etiology: an epidemiologic review

et al. 2017

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“…In many of these areas, epidemics of CKD are also being reported [59][60][61]. A major concern is that these epidemics may be driven by increasing temperatures and heat waves, and that they may presage epidemics to come.…”

Section: Heat Stress Nephropathy As a Cause Of Ckdmentioning

confidence: 99%

Climate Change and the Kidney

et al. 2019

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The worldwide increase in temperature has resulted in a marked increase in heat waves (heat extremes) that carries a markedly increased risk for morbidity and mortality. The kidney has a unique role not only in protecting the host from heat and dehydration but also is an important site of heat-associated disease. Here we review the potential impact of global warming and heat extremes on kidney diseases. High temperatures can result in increased core temperatures, dehydration, and blood hyperosmolality. Heatstroke (both clinical and subclinical whole-body hyperthermia) may have a major role in causing both acute kidney disease, leading to increased risk of acute kidney injury from rhabdomyolysis, or heat-induced inflammatory injury to the kidney. Recurrent heat and dehydration can result in chronic kidney disease (CKD) in animals and theoretically plays a role in epidemics of CKD developing in hot regions of the world where workers are exposed to extreme heat. Heat stress and dehydration also has a role in kidney stone formation, and poor hydration habits may increase the risk for recurrent urinary tract infections. The resultant social and economic consequences include disability and loss of productivity and employment. Given the rise in world temperatures, there is a major need to better understand how heat stress can induce kidney disease, how best to provide adequate hydration, and ways to reduce the negative effects of chronic heat exposure.

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Profile of chronic kidney disease from a nephrology underserviced region in North Eastern India: a preliminary report from a single center in Assam

Nayak-Rao

2023

Int Urol Nephrol

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Uddanam Nephropathy/Regional Nephropathy in India: Preliminary Findings and a Plea for Further Research

Cited by 57 publications

References 36 publications

Pesticide exposures and chronic kidney disease of unknown etiology: an epidemiologic review

Pesticide exposures and chronic kidney disease of unknown etiology: an epidemiologic review

Climate Change and the Kidney

Profile of chronic kidney disease from a nephrology underserviced region in North Eastern India: a preliminary report from a single center in Assam

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