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Claudel SE, Waikar SS. Systematic Review of Kidney Injury Biomarkers for the Evaluation of CKD of Uncertain Etiology. Kidney Int Rep 2024; 9:1614-1632. [PMID: 38899184 PMCID: PMC11184258 DOI: 10.1016/j.ekir.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Chronic kidney disease of uncertain etiology (CKDu) is an incompletely defined phenotype of chronic kidney disease (CKD) affecting young individuals mostly in agricultural communities in Central America and South Asia. CKDu is a diagnosis of exclusion made in individuals from endemic regions. Methods We conducted a systematic review of the primary literature on urinary and plasma kidney injury biomarkers measured in the setting of CKDu (through February 2023). The literature was identified via a Web of Science search and hand search of the references of previously identified literature. Search terms included "CKDu," "Mesoamerican Nephropathy," "CKD of unknown etiology," "Chronic Interstitial Nephritis in Agricultural Communities," "biomarker," "urin∗," and/or "plasma." Results A total of 25 papers were included. The 2 most frequently measured biomarkers were urinary kidney injury molecule-1 (KIM-1) and urinary neutrophil gelatinase-associated lipocalin (NGAL). There was substantial variability in study design, laboratory assay methods, and statistical methodology, which prohibited meta-analysis. Conclusion Biomarkers that identify tubulointerstitial disease early and accurately may substantially accelerate progress in the study of CKDu and facilitate public health approaches that eventually lead to its prevention and elimination. To date, the literature is limited by relatively small sample sizes and methodological limitations which should be addressed in future studies.
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Affiliation(s)
- Sophie E. Claudel
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sushrut S. Waikar
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Holliday MW, Majeti RN, Sheikh-Hamad D. Chronic Interstitial Nephritis in Agricultural Communities: Observational and Mechanistic Evidence Supporting the Role of Nephrotoxic Agrochemicals. Clin J Am Soc Nephrol 2024; 19:538-545. [PMID: 37678249 PMCID: PMC11020436 DOI: 10.2215/cjn.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
Chronic interstitial nephritis in agricultural communities (CINAC) is an epidemic of kidney disease affecting specific tropical and subtropical regions worldwide and is characterized by progressive CKD in the absence of traditional risk factors, such as hypertension and diabetes. CINAC prevalence is higher among young, male agricultural workers, but it also affects women, children, and nonagricultural workers in affected areas. Biopsies from patients with CINAC across regions commonly demonstrate tubular injury with lysosomal aggregates, tubulointerstitial inflammation, and fibrosis and variable glomerular changes. Each endemic area holds environmental risk factors and patient/genetic milieus, resulting in uncertainty about the cause(s) of the disease. Currently, there is no specific treatment available for CINAC. We highlight survey findings of Houston-based migrant workers with CINAC and draw similarities between kidney injury phenotype of patients with CINAC and mice treated chronically with paraquat, an herbicide used worldwide. We propose potential pathways and mechanisms for kidney injury in patients with CINAC, which may offer clues for potential therapies.
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Affiliation(s)
- Michael W. Holliday
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
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3
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Nieves MC, Powers A, Anand S, Vlahos P. Kidney disease hotspots and water balance in a warming world. Curr Opin Nephrol Hypertens 2024; 33:122-129. [PMID: 37889529 PMCID: PMC11027962 DOI: 10.1097/mnh.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW Geographically localized areas with a high prevalence of kidney disease exist currently in several regions of the world. Although the exact cause is unclear, environmental exposures accelerated by climate change, particularly heat exposure and ground water contamination, are hypothesized as putative risk factors. Aiming to inform investigations of water-related exposures as risk factors for kidney disease, we excavate the history of major water sources in three regions that are described as hotspots of kidney disease: the low-lying coastal regions in El Salvador and Nicaragua, the dry central region in Sri Lanka, and the Central Valley of California. RECENT FINDINGS Historic data indicate that these regions have experienced water scarcity to which several human-engineered solutions were applied; these solutions could be hypothesized to increase residents' exposure to putative kidney toxins including arsenic, fluoride, pesticides, and cyanobacteria. Combined with heat stress experienced in context of climate change, there is potential for multistressor effects on kidney function. Climate change will also amplify water scarcity, and even if regional water sources are not a direct risk factor for development of kidney disease, their scarcity will complicate the treatment of the relatively larger numbers of persons with kidney disease living in these hotspots. SUMMARY Nephrologists and kidney disease researchers need to engage in systematic considerations of environmental exposures as potential risk factors for kidney disease, including water sources, their increasing scarcity, and threats to their quality due to changing climate.
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Affiliation(s)
| | - Angelina Powers
- Division of Nephrology, Stanford University School of Medicine
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine
| | - Penny Vlahos
- Department of Marine Sciences, University of Connecticut
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Schreurs G, Maudsley S, Nast C, Praet M, Da Silva Fernandes S, Boor P, D'Haese P, De Broe ME, Vervaet BA. Chronic dehydration induces injury pathways in rats, but does not mimic histopathology of chronic interstitial nephritis in agricultural communities. Sci Rep 2023; 13:18119. [PMID: 37872220 PMCID: PMC10593944 DOI: 10.1038/s41598-023-43567-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
CINAC-patients present renal proximal tubular cell lysosomal lesions which are also observed in patients experiencing calcineurin inhibitor (CNI) nephrotoxicity, suggesting that CINAC is a toxin-induced nephropathy. An alternative hypothesis advocates chronic dehydration as a major etiological factor for CINAC. Here, we evaluated histological and molecular changes in dehydrated versus toxin exposed rats. Wistar rats were divided in 3 groups. Group 1 (n = 6) had free access to drinking water (control group). Group 2 (n = 8) was water deprived for 10 h per 24 h, 5 days/week and placed in an incubator (37 °C) for 30 min/h during water deprivation. Group 3 (n = 8) underwent daily oral gavage with cyclosporine (40 mg/kg body weight). After 28 days, renal function, histopathology and proteomic signatures were analysed. Cyclosporine-treated rats developed focal regions of atrophic proximal tubules with associated tubulo-interstitial fibrosis. PASM staining revealed enlarged argyrophilic granules in affected proximal tubules, identified as lysosomes by immunofluorescent staining. Electron microscopy confirmed the enlarged and dysmorphic phenotype of the lysosomes. Overall, these kidney lesions resemble those that have been previously documented in farmers with CINAC. Dehydration resulted in none of the above histopathological features. Proteomic analysis revealed that dehydration and cyclosporine both induce injury pathways, yet of a clear distinct nature with a signature of toxicity only for the cyclosporine group. In conclusion, both cyclosporine and dehydration are injurious to the kidney. However, dehydration alone does not result in kidney histopathology as observed in CINAC patients, whereas cyclosporine administration does. The histopathological analogy between CINAC and calcineurin inhibitor nephrotoxicity in rats and humans supports the involvement of an as-yet-unidentified environmental toxin in CINAC etiology.
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Affiliation(s)
- Gerd Schreurs
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Stuart Maudsley
- Receptor Biology Lab, Department of Biomedical Science, University of Antwerp, Antwerp, Belgium
| | | | - Marleen Praet
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | | | - Peter Boor
- Institute of Pathology, Electron Microscopy Facility and Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Patrick D'Haese
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Marc E De Broe
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Benjamin A Vervaet
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium.
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany.
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Wijkström J, Annadata KC, Elinder CG, Kolla PK, Sarvepalli NR, Ring A, Swaminathan R, Gunabooshanam B, Söderberg M, Venugopal V, Wernerson A. Clinical findings and kidney morphology in chronic kidney disease of unknown cause in India. J Intern Med 2023; 294:492-505. [PMID: 37400986 DOI: 10.1111/joim.13690] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Chronic kidney disease of unknown cause (CKDu) is an emerging health problem in India and other countries worldwide. However, clinical descriptions, including kidney pathology, are scarce. METHODS This is a descriptive case series of patients with CKDu from an endemic region in India, with a focus on clinical and biochemical characteristics, kidney biopsy findings, and environmental exposure. Patients with suspected CKDu, aged 20-65, and eGFR 30-80 mL/min/1.73 m2 from rural areas with endemic prevalence of CKDu were included. The exclusion criteria were diabetes mellitus, uncontrolled hypertension, proteinuria >1 g/24 h, or other known kidney diseases. The participants underwent kidney biopsies, and blood and urine samples were collected. RESULTS Fourteen participants (3 females, 11 males) with a mean eGFR of 53 (range 29-78) mL/min/1.73 m2 were included. Kidney biopsies showed a combination of chronic tubulointerstitial damage, glomerulosclerosis, and glomerular hypertrophy, with varying degrees of interstitial inflammation. Eight participants had polyuria (diuresis ≥ 3 L/day). The urinary sediments were bland, with no haematuria. Serum potassium and sodium levels were, in most cases, normal but within the lower reference interval. CONCLUSION The kidney morphology and clinical characteristics in patients with CKDu in India were similar to those described for CKDu in Central America and Sri Lanka.
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Affiliation(s)
- Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | | | - Carl-Gustaf Elinder
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | | | | | - Anneli Ring
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Rajendiran Swaminathan
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Barathi Gunabooshanam
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Magnus Söderberg
- Clinical Pharmacology and Safety Sciences, AstraZeneca R&D, Gothenburg, Sweden
| | - Vidhya Venugopal
- Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Ekanayake EMDV, De Silva PMCS, Gunasekara TDKSC, Thakshila WAKG, Gunarathna SD, Pinipa RAI, Jayasinghe S, Chandana EPS, Wijewickrama ES, Jayasundara N. Prevalence of Chronic Kidney Disease of Uncertain Etiology Within Selected Farming Communities in Rural Sri Lanka. Can J Kidney Health Dis 2023; 10:20543581231199013. [PMID: 37771543 PMCID: PMC10524071 DOI: 10.1177/20543581231199013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/14/2023] [Indexed: 09/30/2023] Open
Abstract
Background Chronic kidney disease of uncertain etiology (CKDu) is an emergent health concern, particularly in tropical farming communities in several global hotspots, including Sri Lanka. This particular nephropathy is characterized by a progressive decline in kidney function in the absence of conventional chronic kidney disease (CKD) risk factors such as diabetes mellitus, hypertension, and other identifiable kidney disorders. As it is almost asymptomatic at early stages, CKDu is mostly diagnosed at late stages with significant kidney damage. Hence, the identification of disease susceptibility and vulnerable communities at the earliest possible instances is highly important for the management of the disease. Objective We aimed to compare kidney health across three different farming communities in Sri Lanka to identify CKDu susceptibilities. Methods A cross-sectional study was performed with three selected farming communities: paddy farmers (PF; N = 581), sugarcane farmers (SF; N = 550), and vegetable farmers (VF; N = 244) in comparison with an age-matched control group of nonfarming (NF; N = 225) individuals. A medical examination was performed to investigate health status and medical history, whereas a urinalysis was performed to determine creatinine and albumin contents. Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR) were used for assessment of kidney function. CKDu susceptibility was determined based on eGFR, and urinary ACR adhering to the clinical practice guidelines in Sri Lanka. Results The median (interquartile range [IQR]) eGFR levels of PF (85 mL/min/1.73 m2 [72-97]) and SF (93 mL/min/1.73 m2 [73-112]) were significantly lower than that of the NF group (103 mL/min/1.73 m2 [87-125]) (P < .0001), whereas eGFR of VF (100 mL/min/1.73 m2 [80-111]) was not significantly different compared with NF. The median (IQR) urinary ACR levels of the study groups, PF, SF, VF, and NF, were 0.59 (0.26-1.45), 0.46 (0.28-0.88), 0.45 (0.34-0.90), and 0.44 (0.34-1.02) mg/mmol, respectively. However, urinary ACR did not differ significantly across the study groups (P > .05). The prevalence of CKDu within PF (13.60%), SF (12.54%), and VF (6.67%) communities was significantly higher (P < .05) compared with the NF (2.67%). Of the total CKD cases, CKDu susceptible cases represented 73%, 69%, 50%, and 25% in PF, SF, VF, and NF, respectively, indicating a high risk of CKDu susceptibility among farming communities. Moreover, a noteworthy association of CKDu was observed with agrochemical exposure (odds ratio [OR] = 3.11, 95% confidence interval [CI] = 1.36-7.09). Concerning the farming practices, sugarcane farming showed the highest association with CKDu prevalence (OR = 3.40, 95% CI = 1.49-7.78). Conclusions Compared with the nonfarming group, a significant risk of CKDu was observed in the three farming communities, particularly among paddy and sugarcane farmers. Longitudinal epidemiological studies to identify vulnerable farming communities and associated risk factors are critically needed to develop effective management strategies against CKDu within farming communities.
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Affiliation(s)
- E. M. D. V. Ekanayake
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, Sri Lanka
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, USA
| | | | | | | | - S. D. Gunarathna
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, Sri Lanka
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, USA
| | - R. A. I. Pinipa
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, Sri Lanka
| | - Sudheera Jayasinghe
- Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - E. P. S. Chandana
- Department of Biosystems Technology, Faculty of Technology, University of Ruhuna, Matara, Sri Lanka
| | - E. S. Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
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Deng R, Liu Q, Cui C, Yao T, Long J, Asad Z, Womick RM, Zhu Z, Fogo AB, Zhao S, Yang H, Huo Y. Omni-Seg: A Scale-Aware Dynamic Network for Renal Pathological Image Segmentation. IEEE Trans Biomed Eng 2023; 70:2636-2644. [PMID: 37030838 PMCID: PMC10517077 DOI: 10.1109/tbme.2023.3260739] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
Comprehensive semantic segmentation on renal pathological images is challenging due to the heterogeneous scales of the objects. For example, on a whole slide image (WSI), the cross-sectional areas of glomeruli can be 64 times larger than that of the peritubular capillaries, making it impractical to segment both objects on the same patch, at the same scale. To handle this scaling issue, prior studies have typically trained multiple segmentation networks in order to match the optimal pixel resolution of heterogeneous tissue types. This multi-network solution is resource-intensive and fails to model the spatial relationship between tissue types. In this article, we propose the Omni-Seg network, a scale-aware dynamic neural network that achieves multi-object (six tissue types) and multi-scale (5× to 40× scale) pathological image segmentation via a single neural network. The contribution of this article is three-fold: (1) a novel scale-aware controller is proposed to generalize the dynamic neural network from single-scale to multi-scale; (2) semi-supervised consistency regularization of pseudo-labels is introduced to model the inter-scale correlation of unannotated tissue types into a single end-to-end learning paradigm; and (3) superior scale-aware generalization is evidenced by directly applying a model trained on human kidney images to mouse kidney images, without retraining. By learning from 150,000 human pathological image patches from six tissue types at three different resolutions, our approach achieved superior segmentation performance according to human visual assessment and evaluation of image-omics (i.e., spatial transcriptomics).
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Sandanayake S, Diyabalanage S, Edirisinghe EANV, Guo H, Vithanage M. Hydrogeochemical characterization of groundwater with a focus on Hofmeister ions and water quality status in CKDu endemic and CKDu non‒endemic areas, Sri Lanka. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 328:121596. [PMID: 37037276 DOI: 10.1016/j.envpol.2023.121596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/07/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023]
Abstract
Hydro-geochemistry of drinking water was characterized in chronic kidney disease of unknown etiology (CKDu) endemic areas in Girandurukotte (GK) and Dehiattakandiya (DH) and non-endemic areas in GK, DH, and Sewanagala (SW) in Sri Lanka to comprehend any potential risk factors for CKDu. Groundwater (n = 142) and surface water (n = 08) were sampled during wet and dry seasons and analyzed for major anions, cations and stable isotopes of hydrogen and oxygen (δ2H and δ18O). Besides the typical water quality analysis, the water quality status was determined using the weighted arithmetic water quality index (WQI) and Hofmeister ion exposure levels. The measured average groundwater F- level was higher than the permissible level assigned by regulatory agencies for tropical countries at CKDu locations in GK, DH and non-CKDu locations in DH and SW. Significant differences in the content of total hardness (p = 0.017) and total dissolved solids (p = 0.003) were observed between CKDu and non-CKDu locations whereas the differences were insignificant for F- (p = 0.985) and alkalinity (p = 0.203). Weathering of silicate and carbonate minerals was found to be the main governing factor of groundwater compositions in both CKDu and non-CKDu areas, while recharging of groundwater is mainly determined by the rainfall than the surface water inputs. Higher ionic strength of groundwater in non-CKDu areas suggested that the potential environmental CKDu risk factors might be suppressed from dissolution into groundwater. The WQI calculations revealed that the both CKDu and non-CKDu locations were frequently presented with poor water quality. This study highlights the water quality status of the CKDu and non-CKDu locations and signifies the potential health risks that could arise even in non-CKDu areas due to the consumption of poor quality water. Accordingly, regular monitoring of water quality and assessment of Hofmeister ions exposure from food and beverages are highly warranted.
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Affiliation(s)
- Sandun Sandanayake
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, 10250, Sri Lanka
| | - Saranga Diyabalanage
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, 10250, Sri Lanka; Instrument Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, 10250, Sri Lanka
| | - E A N V Edirisinghe
- Isotope Hydrology Section, Sri Lanka Atomic Energy Board (SLAEB), Wellampitiya, Sri Lanka
| | - Huaming Guo
- Ministry of Education Key Laboratory of Groundwater Circulation and Environmental Evolution & School of Water Resources and Environment, China University of Geosciences (Beijing), Beijing, China
| | - Meththika Vithanage
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, 10250, Sri Lanka.
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9
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H Hathaway M, L Patil C, Odhiambo A, Onyango D, Dorevitch S. Prevalence and predictors of chronic kidney disease of undetermined causes (CKDu) in Western Kenya's "sugar belt": a cross-sectional study. BMC Nephrol 2023; 24:157. [PMID: 37280533 DOI: 10.1186/s12882-023-03213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Epidemics of chronic kidney disease of undetermined causes (CKDu) among young male agricultural workers have been observed in many tropical regions. Western Kenya has similar climatic and occupational characteristics as many of those areas. The study objectives were to characterize prevalence and predictors of CKDu, such as, HIV, a known cause of CKD, in a sugarcane growing region of Kenya; and to estimate prevalence of CKDu across occupational categories and evaluate if physically demanding work or sugarcane work are associated with reduced eGFR. METHODS The Disadvantaged Populations eGFR Epidemiology Study (DEGREE) protocol was followed in a cross-sectional study conducted in Kisumu County, Western Kenya. Multivariate logistic regression was performed to identify predictors of reduced eGFR. RESULTS Among 782 adults the prevalence of eGFR < 90 was 9.85%. Among the 612 participants without diabetes, hypertension, and heavy proteinuria the prevalence of eGFR < 90 was 8.99% (95%CI 6.8%, 11.5%) and 0.33% (95%CI 0.04%, 1.2%) had eGFR < 60. Among the 508 participants without known risk factors for reduced eGFR (including HIV), the prevalence of eGFR < 90 was 5.12% (95%CI 3.4%, 7.4%); none had eGFR < 60. Significant risk factors for reduced eGFR were sublocation, age, body mass index, and HIV. No association was found between reduced eGFR and work in the sugarcane industry, as a cane cutter, or in physically demanding occupations. CONCLUSION CKDu is not a common public health problem in this population, and possibly this region. We recommend that future studies should consider HIV to be a known cause of reduced eGFR. Factors other than equatorial climate and work in agriculture may be important determinants of CKDu epidemics.
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Affiliation(s)
- Michelle H Hathaway
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL, 60612, USA.
| | - Crystal L Patil
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, 845 S. Damen Ave., MC 802, Chicago, IL, 60612, USA
| | - Aloyce Odhiambo
- Safe Water and AIDS Project, Behind Royal City Garden Hotel, Milimani Estate, Off Aga Khan Road, P.O. Box, Kisumu, 3323-40100, Kenya
| | - Dickens Onyango
- County Department of Health, County Government of Kisumu, Kisumu, Kenya
| | - Samuel Dorevitch
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL, 60612, USA
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Sharma S, Sharma N, Anandh U, Gowrishankar S. Chronic Tubulointerstitial Nephropathy of Agricultural Communities. KIDNEY AND DIALYSIS 2023; 3:229-243. [DOI: 10.3390/kidneydial3020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Chronic interstitial nephritis in agricultural communities is an emerging public health concern affecting numerous agricultural communities in tropical countries, including regions in India, with a significant impact on the health and well-being of affected individuals. The affected individuals suffer from various psychosocial, nutritional, and metabolic challenges due to organ failure, which affects their quality of life. The etiology remains poorly understood, and various risk factors, which include various environmental and occupational hazards, have been implicated in its development. The recent discovery of lysosomal proximal tubulopathy has reignited interest in its pathogenesis. Along with the representative feature of chronic interstitial nephritis, changes suggestive of tubular injury have also been reported. It is suggested to use the term “chronic tubulointerstitial nephropathy of agricultural community” instead of chronic interstitial nephritis of the agricultural communities. Chronic tubulointerstitial nephropathy in agricultural communities is a slowly progressive disease that initially does not cause any symptoms in patients and most patients have a delayed onset of symptoms. Several diagnostic criteria have been introduced over the past years and one introduced by the Ministry of Health of Sri Lanka is widely used. The management of this chronic illness is no different from other causes of chronic interstitial nephritis and our focus should be on implementing various preventive strategies to reduce its incidence in agricultural communities and protect the health and well-being of agricultural workers. By disseminating knowledge about chronic tubulointerstitial nephropathy in agricultural communities, we can contribute to the development of evidence-based interventions to reduce the burden of the disease on affected communities. Moreover, we would like to sensitize physicians to this entity to increase awareness and identify potential endemic areas in various agricultural communities.
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Affiliation(s)
- Sourabh Sharma
- Department of Nephrology, Vardhman Mahavir Medical College, Safdarjung Hospital, Delhi 110029, India
| | - Neha Sharma
- Department of Pathology, Vardhman Mahavir Medical College, Safdarjung Hospital, Delhi 110029, India
| | - Urmila Anandh
- Department of Nephrology, Amrita Hospitals, Faridabad 121002, India
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11
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Daniel C, Enghard P, Ratnatunga N, Wijetunge S, Wazil A, Zwiener C, Barth JA, Chandrajith R, Klewer M, Eckhardt KU, Amann K, Freund P, Premarathne S, Pushpakumara W, Nanayakkara N. Early Ultrastructural Changes in Biopsies From Patients With Symptomatic CKD of Uncertain Etiology. Kidney Int Rep 2023; 8:642-657. [PMID: 36938087 PMCID: PMC10014386 DOI: 10.1016/j.ekir.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction Although the investigation of chronic kidney disease of uncertain etiology (CKDu) has identified many possible influencing factors in recent years, the exact pathomechanism of this disease remains unclear. Methods In this study, we collected 13 renal biopsies from patients with symptomatic CKDu (Sym-CKDu) from Sri Lanka with well-documented clinical and socioeconomic factors. We performed light microscopy and electron microscopic evaluation for ultrastructural analysis, which was compared with 100 biopsies from German patients with 20 different kidney diseases. Results Of the 13 Sri Lankan patients, 12 were men (92.3%), frequently employed in agriculture (50%), and experienced symptoms such as feeling feverish (83.3%), dysuria (83.3%), and arthralgia (66.6%). Light microscopic evaluation using activity and chronicity score revealed that cases represented early stages of CKDu except for 2 biopsies, which showed additional signs of diabetes. Most glomeruli showed only mild changes, such as podocyte foot process effacement on electron microscopy. We found a spectrum of early tubulointerstitial changes including partial loss of brush border in proximal tubules, detachment of tubular cells, enlarged vacuoles, and mitochondrial swelling associated with loss of cristae and dysmorphic lysosomes with electron-dense aggregates. None of these changes occurred exclusively in Sym-CKDu; however, they were significantly more frequent in these cases than in the control cohort. Conclusion In conclusion, our findings confirm the predominant and early alterations of tubular structure in CKDu that can occur without significant glomerular changes. The ultrastructural changes do not provide concrete evidence of the cause of CKDu but were significantly more frequent in Sym-CKDu than in the controls.
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Affiliation(s)
- Christoph Daniel
- Department of Nephropathology, Institute of Pathology, Friedrich–Alexander Universität, Erlangen-Nuremberg, Erlangen, Germany
| | - Philipp Enghard
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sulochana Wijetunge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - A.W.M. Wazil
- Nephrology and Kidney Transplant Unit, National Hospital, Kandy, Sri Lanka
| | - Christian Zwiener
- Environmental Analytical Chemistry, Department of Geosciences, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Johannes A.C. Barth
- Department of Geography and Geosciences, Friedrich–Alexander-Universtiät Erlangen-Nuremberg, GeoZentrum Nordbayern, Erlangen, Germany
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Monika Klewer
- Department of Nephropathology, Institute of Pathology, Friedrich–Alexander Universität, Erlangen-Nuremberg, Erlangen, Germany
| | - Kai-Uwe Eckhardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | - Kerstin Amann
- Department of Nephropathology, Institute of Pathology, Friedrich–Alexander Universität, Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Freund
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | | | | | - Nishantha Nanayakkara
- Nephrology and Kidney Transplant Unit, National Hospital, Kandy, Sri Lanka
- Correspondence: Nishantha Nanayakkara, Center for Research, National Hospital Kandy, Kandy, Sri Lanka.
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12
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Sasai F, Roncal-Jimenez C, Rogers K, Sato Y, Brown JM, Glaser J, Garcia G, Sanchez-Lozada LG, Rodriguez-Iturbe B, Dawson JB, Sorensen C, Hernando AA, Gonzalez-Quiroz M, Lanaspa M, Newman LS, Johnson RJ. Climate change and nephrology. Nephrol Dial Transplant 2023; 38:41-48. [PMID: 34473287 PMCID: PMC9869860 DOI: 10.1093/ndt/gfab258] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 01/26/2023] Open
Abstract
Climate change should be of special concern for the nephrologist, as the kidney has a critical role in protecting the host from dehydration, but it is also a favorite target of heat stress and dehydration. Here we discuss how rising temperatures and extreme heat events may affect the kidney. The most severe presentation of heat stress is heat stroke, which can result in severe electrolyte disturbance and both acute and chronic kidney disease (CKD). However, lesser levels of heat stress also have multiple effects, including exacerbating kidney disease and precipitating cardiovascular events in subjects with established kidney disease. Heat stress can also increase the risk for kidney stones, cause multiple electrolyte abnormalities and induce both acute and chronic kidney disease. Recently there have been multiple epidemics of CKD of uncertain etiology in various regions of the world, including Mesoamerica, Sri Lanka, India and Thailand. There is increasing evidence that climate change and heat stress may play a contributory role in these conditions, although other causes, including toxins, could also be involved. As climate change worsens, the nephrologist should prepare for an increase in diseases associated with heat stress and dehydration.
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Affiliation(s)
- Fumihiko Sasai
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carlos Roncal-Jimenez
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Keegan Rogers
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Yuka Sato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jared M Brown
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Gabriela Garcia
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Bernardo Rodriguez-Iturbe
- Laboratory of Renal Physiopathology, Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City
- Instituto Nacional de Cencias Médicas y Nutrición "Salvador Zubirán", Department of Nephrology, Mexico City, Mexico
| | - Jaime Butler Dawson
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cecilia Sorensen
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ana Andres Hernando
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marvin Gonzalez-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
- Centre for Nephrology, University College London, London, UK
| | - Miguel Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lee S Newman
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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13
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Figueroa-Solis E, Gimeno Ruiz de Porras D, Rojas-Garbanzo M, Whitehead L, Zhang K, Delclos GL. Prevalence and Geographic Distribution of Self-Reported Chronic Kidney Disease and Potential Risk Factors in Central America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1308. [PMID: 36674063 PMCID: PMC9859154 DOI: 10.3390/ijerph20021308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cases for chronic kidney disease of unknown etiology (CKDu) are increasing in specific disease hotspots located in rural agricultural communities over Central America. The goal of the study was to estimate the prevalence and geographic distribution of self-reported work-related CKD and associated risk factors for CKDu by industry sector in Central America. METHODS We calculated the prevalence and distribution of self-reported CKD, work-related CKD, and suspected CKDu risk factors among the 9032 workers in the Second Central American Survey of Working Conditions and Health (II ECCTS, 2018). We mapped the distribution of suspected CKDu risk factors to work-related CKDu and weather conditions using average annual temperatures. RESULTS The primary and secondary industry sectors showed the highest proportion of males, suspected CKDu risk factors, and work-related CKD. Age (30-49 years: OR = 2.38, 95% CI 1.03-5.51), ethnicity (mestizo: OR, 7.44, 95% CI: 2.14-25.82), and exposure to high physical work demands (OR = 2.45, 95% CI: 1.18-5.09) were associated with work-related CKD. The majority of work-related CKD were reported in the western parts of Honduras and Nicaragua, in hot temperature regions, and overlapped with those areas with a high density of CKDu risk factors. Finally, some areas clustered CKDu risk factors without any work-related CKD points, mainly in the western part of Guatemala. CONCLUSION Our findings supplement prior CKDu findings regarding a high prevalence of work-related CKD among 30- to 49-year-old mestizo males in the primary and secondary sectors, in hot temperature areas, in the central and western region, and overlapping with persons reporting two or more CKDu risk factors. Moreover, several geographic areas with CKDu risk factor clusters had no reported work-related CKD. These areas represent new industries and sectors to be monitored for possible future increases of CKDu cases.
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Affiliation(s)
- Erika Figueroa-Solis
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
| | - David Gimeno Ruiz de Porras
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, San Antonio, TX 78229, USA
| | - Marianela Rojas-Garbanzo
- Instituto Regional de Estudios en Sustancias Tóxicas (IRET), National University of Costa Rica, Heredia 40101, Costa Rica
| | - Lawrence Whitehead
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Albany, NY 12144, USA
| | - George L. Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
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14
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Badurdeen Z, Ratnatunga N, Abeysekera T, Wazil AWM, Rajakrishna PN, Thinnarachchi JP, Welagedera DD, Ratnayake N, Alwis APD, Abeysundara H, Kumarasiri R, Taylor R, Nanayakkara N. Randomized control trial of prednisolone and doxycycline in patients with acute interstitial nephritis of unknown aetiology. Trials 2023; 24:11. [PMID: 36600250 DOI: 10.1186/s13063-022-07056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients presenting with acute interstitial nephritis (AIN) of unknown aetiology, probably the earliest presentation of chronic kidney disease of unknown aetiology (CKDu), have been treated with oral prednisolone and doxycycline by physicians in Sri Lanka. This trial assessed the effectiveness of prednisolone and doxycycline based on eGFR changes at 6 months in patients with AIN of unknown aetiology. METHOD A randomized clinical trial with a 2 × 2 factorial design for patients presenting with AIN of unknown aetiology (n = 59) was enacted to compare treatments with; A-prednisolone, B-doxycycline, C-both treatments together, and D-neither. The primary outcome was a recovery of patients' presenting renal function to eGFR categories: 61-90 ml/min/1.73m2 (complete remission- CR) to 31-60 ml/min/1.73m2 (partial remission- PR) and 0-30 ml/min/1.73m2 no remission (NR) by 6 months. A secondary outcome was progression-free survival (not reaching < 30 ml/min/1.73m2 eGFR), by 6-36 months. Analysis was by intention to treat. RESULTS Seventy patients compatible with a clinical diagnosis of AIN were biopsied for eligibility; 59 AIN of unknown aetiology were enrolled, A = 15, B = 15, C = 14 and D = 15 randomly allocated to each group. Baseline characteristics were similar between groups. The number of patients with CR, PR and NR, respectively, by 6 months, in group A 3:8:2, group B 2:8:3 and group C 8:5:0 was compared with group D 8:6:1. There were no significant differences found between groups A vs. D (p = 0.2), B vs. D (p = 0.1) and C vs. D (p = 0.4). In an exploratory analysis, progression-free survival in prednisolone-treated (A + C) arms was 0/29 (100%) in comparison to 25/30 (83%) in those not so treated (B + D) arms, and the log-rank test was p = 0.02, whereas no such difference found (p = 0.60) between doxycycline-treated (B + C) arms 27/29 (93%) vs those not so treated (A + D) arms 27/30 (90%). CONCLUSION Prednisolone and doxycycline were not beneficial for the earliest presentation of CKDu at 6 months. However, there is a potential benefit of prednisolone on the long-term outcome of CKDu. An adequately powered steroid trial using patients reaching < 30 ml/min/1.73m2 eGFR by 3 years, as an outcome is warranted for AIN of unknown aetiology. TRIAL REGISTRATION Sri Lanka Clinical Trial Registry SLCTR/2014/007, Registered on the 31st of March 2014.
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Affiliation(s)
- Zeid Badurdeen
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Tilak Abeysekera
- Renal Transplant and Dialysis Unit, Teaching Hospital, Kandy, Sri Lanka
| | - Abdul W M Wazil
- Renal Transplant and Dialysis Unit, Teaching Hospital, Kandy, Sri Lanka
| | | | | | | | - Nadeeka Ratnayake
- Renal Transplant and Dialysis Unit, Teaching Hospital, Kandy, Sri Lanka
| | | | - Hemalika Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Ranjith Kumarasiri
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Richard Taylor
- School of Public Health and Community Medicine (SPHCM), Faculty of Medicine, University of New South Wales (UNSW), Kensington, Australia
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15
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Kader SA, Spalevic V, Dudic B. Feasibility study for estimating optimal substrate parameters for sustainable green roof in Sri Lanka. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2022; 26:1-27. [PMID: 36570522 PMCID: PMC9768404 DOI: 10.1007/s10668-022-02837-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/11/2022] [Indexed: 06/01/2023]
Abstract
In twenty-first century buildings, green roof systems are envisioned as great solution for improving Environmental sustainability in urban ecosystems and it helps to mitigate various health hazards for humans due to climatic pollution. This study determines the feasibility of using five domestic organic wastes, including sawdust, wood bark, biochar, coir, and compost, as sustainable substrates for green roofs as compared to classical Sri Lankan base medium (fertiliser + potting mix) in terms of physicochemical and biological parameters associated with growing mediums. Comprehensive methodologies were devised to determine the thermal conductivity and electric conductivity of growing mediums. According to preliminary experimental results, the most suitable composition for green roof substrates comprised 60% organic waste and 40% base medium. Sawdust growing medium exhibited the highest moisture content and minimum density magnitudes. Biochar substrate was the best performing medium with the highest drought resistance and vegetation growth. The wood bark substrate had the highest thermal resistance. Growing mediums based on compost, sawdust, and coir produced the best results in terms of nitrate, phosphate, pH, and electric conductivity (EC) existence. This study provided a standard set of comprehensive comparison methodologies utilising physicochemical and biological properties required for substrate characterization. The findings of this research work have strong potential in the future to be used in selecting the most suitable lightweight growing medium for a green roof based on stakeholder requirements.
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Affiliation(s)
- Shuraik A. Kader
- Department of Civil Engineering, Faculty of Engineering, Sri Lanka Institute of Information Technology, Malabe, 10115 Sri Lanka
| | - Velibor Spalevic
- Biotechnical Faculty, University of Montenegro, Podgorica, 81000 Montenegro
| | - Branislav Dudic
- Faculty of Management, Comenius University Bratislava, 82005 Bratislava, Slovakia
- Department of Engineering Management in Agribusiness, University Business Academy in Novi Sad, 21000 Novi Sad, Serbia
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16
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Gamage CD, Nanayakkara S, Sarathkumara YD, Muthusinghe DS, Shimizu K, Arikawa J, Lokupathirage SMW, Nanayakkara N, Gunarathne L, Chandrajith R, Harada KH, Koizumi A, Yoshimatsu K. Hantavirus infection as a risk factor for chronic kidney disease of unknown aetiology (CKDu) and its prevalence in endemic areas of Sri Lanka since 2010 according to a retrospective serological analysis. J Med Microbiol 2022; 71. [PMID: 36748416 DOI: 10.1099/jmm.0.001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. Chronic kidney disease of unknown aetiology (CKDu) is a major public health problem in Sri Lanka, especially among agrarian communities. Although the cause of CKDu is still unknown, hantavirus infection has been proposed as a risk factor.Methods. This study was performed using serological samples collected from two CKDu-endemic areas, Anuradhapura (2010) and Badulla districts (2010 and 2016), and a non-endemic area, Matale (2016) district. The presence of anti-Thailand orthohantavirus IgG antibodies was investigated in serum samples. Hantavirus seroprevalence and demographic data were epidemiologically analysed.Results. Seroprevalence was higher in CKDu patients (40.6-60.0 %) and healthy individuals in CKDu-endemic areas (17.6-25.5 %) than in healthy individuals in non-endemic areas (3.0 %). Statistically significant odds ratios (ORs) for hantavirus infection in CKDu patients were detected in CKDu-endemic areas [ORs: 3.2 and 3.1; 95 % confidence interval (CI): 1.8-5.5 and 1.8-5.2 in Anuradhapura and Badulla districts in 2010; and OR: 4.4, 95 % CI: 2.3-8.5 in 2016 in Badulla district). Furthermore, the OR for hantavirus infection in Badulla district has increased in the last decade from 3.1 (95 % CI: 1.8-5.3) to 4.4 (95 % CI: 2.3-8.5).Conclusion. Hantavirus infection has been prevalent in two distant CKDu-endemic areas since 2010. The observed significant association of hantavirus seropositivity with CKDu indicates a possible role of hantavirus infection in CKDu pathogenesis.
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Affiliation(s)
- Chandika D Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, 20400 Peradeniya, Sri Lanka
| | - Shanika Nanayakkara
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Surry Hills, NSW 2010, Australia.,Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8501, Japan
| | - Yomani D Sarathkumara
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, 20400 Peradeniya, Sri Lanka.,Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, QLD 4870, Australia
| | - Devinda S Muthusinghe
- Graduate School of Infectious Diseases, Hokkaido University, Sapporo 060-0815, Japan.,Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815, Japan
| | - Kenta Shimizu
- Department of Microbiology and Immunology, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Jiro Arikawa
- Department of Microbiology and Immunology, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Sithumini M W Lokupathirage
- Graduate School of Infectious Diseases, Hokkaido University, Sapporo 060-0815, Japan.,Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815, Japan
| | - Nishantha Nanayakkara
- Nephrology and Transplantation Unit, Teaching Hospital Kandy, 20000 Kandy, Sri Lanka
| | | | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, 20400 Peradeniya, Sri Lanka
| | - Kouji H Harada
- Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8501, Japan
| | - Akio Koizumi
- Institute of Public Health and Welfare Research, Ukyo-ku, Kyoto 616-8141, Japan.,Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8501, Japan
| | - Kumiko Yoshimatsu
- Graduate School of Infectious Diseases, Hokkaido University, Sapporo 060-0815, Japan.,Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815, Japan
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17
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Holliday MW, Li Q, Bustamante EG, Niu J, Huang L, Espina IM, Dominguez JR, Truong L, Murray KO, Fan L, Anumudu SJ, Shah M, Fischer RS, Vangala C, Mandayam S, Perez J, Pan JS, Ali S, Awan AA, Sheikh-Hamad D. Potential Mechanisms Involved in Chronic Kidney Disease of Unclear Etiology. Clin J Am Soc Nephrol 2022; 17:1293-1304. [PMID: 35944911 PMCID: PMC9625092 DOI: 10.2215/cjn.16831221] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/15/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES The etiology of chronic kidney disease of unclear etiology, also known as Mesoamerican nephropathy, remains unclear. We investigated potential etiologies for Mesoamerican nephropathy in an immigrant dialysis population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Migrants with Mesoamerican nephropathy kidney failure (n=52) were identified by exclusion of known causes of kidney disease and compared using a cross-sectional survey with demographically similar patients with kidney failure from other causes (n=63) and age/sex/place of origin-matched healthy participants (n=16). Survey results were extended to the bench; C57BL/6 mice (n=73) received 10-15 weekly intraperitoneal injections of paraquat (a reactive oxygen species-generating herbicide) or vehicle. Kidney function, histology, and expression of organic cation transporter-2 (proximal tubule entry for paraquat) and multidrug and toxin extrusion 1 (extrusion pathway) were examined. Kidney biopsies from Nicaraguan patients with acute Mesoamerican nephropathy were stained for the above transporters and compared with patients with tubulointerstitial nephritis and without Mesoamerican nephropathy. RESULTS Patients with Mesoamerican nephropathy and kidney failure were young agricultural workers, almost exclusively men; the majority were from Mexico and El Salvador; and they had prior exposures to agrochemicals, including paraquat (27%). After adjustment for age/sex, exposure to any agrochemical or paraquat was associated with Mesoamerican nephropathy kidney failure (odds ratio, 4.86; 95% confidence interval, 1.82 to 12.96; P=0.002 and odds ratio, 12.25; 95% confidence interval, 1.51 to 99.36; P=0.02, respectively). Adjusted for age/sex and other covariates, 1 year of agrochemical exposure was associated with Mesoamerican nephropathy kidney failure (odds ratio, 1.23; 95% confidence interval, 1.04 to 1.44; P=0.02). Compared with 16 matched healthy controls, Mesoamerican nephropathy kidney failure was significantly associated with exposure to paraquat and agrochemicals. Paraquat-treated male mice developed kidney failure and tubulointerstitial nephritis consistent with Mesoamerican nephropathy. Organic cation transporter-2 expression was higher in male kidneys versus female kidneys. Paraquat treatment increased organic cation transporter-2 expression and decreased multidrug and toxin extrusion 1 expression in male kidneys; similar results were observed in the kidneys of Nicaraguan patients with Mesoamerican nephropathy. CONCLUSIONS Exposure to agrochemicals is associated with Mesoamerican nephropathy, and chronic exposure of mice to paraquat, a prototypical oxidant, induced kidney failure similar to Mesoamerican nephropathy.
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Affiliation(s)
- Michael W. Holliday
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Translational Research on Inflammatory Diseases, Houston, Texas
| | - Qingtian Li
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Jingbo Niu
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Luping Huang
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ilse M. Espina
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jose R. Dominguez
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Luan Truong
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas
| | - Kristy O. Murray
- School of Tropical Medicine and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Lei Fan
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Samaya J. Anumudu
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Maulin Shah
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Rebecca S.B. Fischer
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, Houston, Texas
| | - Chandan Vangala
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Sreedhar Mandayam
- Section of Nephrology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jose Perez
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jenny S. Pan
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Sehrish Ali
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ahmed A. Awan
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - David Sheikh-Hamad
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Translational Research on Inflammatory Diseases, Houston, Texas
- Department of Nutrition, Harris Health System, Houston, Texas
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18
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Sasai F, Rogers K, Orlicky DJ, Stem A, Schaeffer J, Garcia G, Fox J, Ray MS, Butler-Dawson J, Gonzalez-Quiroz M, Leiva R, Taduri G, Anutrakulchai S, Venugopal V, Madero M, Glaser J, Wijkstrom J, Wernerson A, Brown J, Roncal-Jimenez CA, Johnson RJ. Inhaled Silica Nanoparticles Causes Chronic Kidney Disease in Rats. Am J Physiol Renal Physiol 2022; 323:F48-F58. [PMID: 35635324 DOI: 10.1152/ajprenal.00021.2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Silica nanoparticles (SiNPs) released during the burning of sugarcane have been postulated to have a role in chronic kidney disease of unknown etiology. We tested the hypothesis that pristine SiNPs of the size present in sugarcane might cause chronic kidney injury when administered through the lung in rats. METHODS We administered 200 nm or 300 nm amorphous SiNPs twice weekly (4 mg/dose) or vehicle by oropharyngeal aspiration for 13 weeks to rats followed by sacrifice after an additional 13 weeks (26 weeks total). Tissues were evaluated for presence of SiNPs and evidence of histologic injury. RESULTS Both sizes of SiNPs caused kidney damage, with early tubular injury and inflammation (at week 13) that continued to inflammation and chronic fibrosis at week 26 despite discontinuing the SiNP administration. Both sizes of SiNPs caused local inflammation in the lung and kidney and were detected in the serum and urine at week 13, and the 200 nm particles also localized to the kidney with no evidence of retention of the 300 nm particles. At week 26 there was some clearance of the 200 nm silica from the kidneys, and urinary levels of SiNPs were reduced but still significant in both the 200 and 300 nm exposed rats. CONCLUSIONS Inhaled SiNPs causes chronic kidney injury that progresses despite stopping the SiNP administration. These findings are consistent with the hypothesis that human exposure to amorphous silica nanoparticles found in burned sugarcane fields could have a participatory role in chronic kidney disease of unknown etiology.
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Affiliation(s)
- Fumihiko Sasai
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Keegan Rogers
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - David J Orlicky
- Department of Pathology, University of Colorado School of Medicine, Denver, Colorado, United States
| | - Arthur Stem
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Joshua Schaeffer
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States.,Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Gabriela Garcia
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Jacob Fox
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Matthew S Ray
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Jaime Butler-Dawson
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Marvin Gonzalez-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
| | - Ricardo Leiva
- Division of Kidney Diseases, Hospital Rosales, San Salvador, El Salvador
| | | | | | - Vidhya Venugopal
- School of Public Health, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Magdalena Madero
- Division of Kidney Diseases, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Julia Wijkstrom
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Jared Brown
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Carlos A Roncal-Jimenez
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Richard J Johnson
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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Applicability of Novel Urinary Biomarkers for the Assessment of Renal Injury in Selected Occupational Groups in Sri Lanka: A Comparative Study with Conventional Markers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095264. [PMID: 35564662 PMCID: PMC9099841 DOI: 10.3390/ijerph19095264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 12/31/2022]
Abstract
Screening approaches with more robust biomarkers, are of the utmost importance in the characterization of renal injuries, particularly among communities with high burdens of chronic kidney disease of uncertain etiology (CKDu). The present study aimed to assess the utility of two emerging biomarkers: kidney injury molecule (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) in predicting renal injury in different occupational groups in Sri Lanka. A cross-sectional study was conducted with six occupational groups (n = 188): fisherfolk (FF), paddy farmers (PF), sugarcane farmers (SF), factory workers (FW) and plantation workers (PW) to assess the predictive performance of KIM-1 and NGAL against a CKDu patient (PT) group (n = 40). The median KIM-1 levels of the study groups; FF, PF, SF, FW, PW and PT were 0.67, 0.59, 0.49, 1.62, 0.67 and 5.24 ng/mgCr, respectively, while the median NGAL levels were 1.16, 2.52, 1.42, 1.71, 1.06 and 22.41 ng/mgCr respectively. In ROC analysis to predict CKDu susceptibility, the area under the curve for KIM-1 ranged from 0.88 to 0.99 for the study groups, and in overall analysis, the sensitivity and specificity were 100% and 96%, respectively, for a cutoff value of 2.76 ng/mgCr. Similarly, for NGAL the range of AUC was 0.78-0.94, and a cutoff value of 3.12 ng/mgCr produced 88% sensitivity and 82% specificity. Compared with conventional markers, KIM-1 was the best biomarker for the characterization of renal injury in the participants of the occupational groups. With further validations, KIM-1 may be adopted as a prognostic marker to identify early renal injury and CKDu susceptibilities in community screening.
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Jolly AM, Thomas J. Chronic kidney disease of unknown etiology in India: a comparative study with Mesoamerican and Sri Lankan nephropathy. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:15303-15317. [PMID: 34984612 DOI: 10.1007/s11356-021-16548-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/11/2021] [Indexed: 06/14/2023]
Abstract
Chronic kidney disease of unknown etiology [CKDu] is a condition characterized by decline in kidney function and is not associated with diabetic nephropathy or hypertensive nephropathy. In this review, we have done a detailed literature analysis on CKDu in India, and then had a comparison with that of Mesoamerica and Sri Lanka. In India, CKDu became the second most common type of CKD after diabetic nephropathy. Silica was seen in the groundwater of both India and Sri Lanka, whereas in Mesoamerica silica exposure through particulate matter was seen among CKDu communities. DDE is a common agrochemical seen in both India and Sri Lanka. The risk factors vary from region to region and it is important to categorize CKDu population based on the risk factors to avoid misinterpretation of the condition as non-CKDu category and to evade further complications. More studies have to be conducted to reveal the detailed pathophysiological mechanisms and its relation with irrational exploitation of environmental resources.
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Affiliation(s)
- Aleeta Maria Jolly
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Jaya Thomas
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India.
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21
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Diaz DMM, Aguirre MDCC, Escalera ALR, Gutiérrez MTT, Robles IO, Guzmán MJM, Díaz ALG, Peña MCG, Alvarado-Nájera AN, Domínguez IG, Villavicencio-Bautista JC, Rodríguez AAH, Marín-García R, González FJA, Wong AC, Guerra EG, Castañeda RD, Aguilar CAP, Zúñiga-Macías LP, Guerra JMA. Histologic characterization and risk factors for persistent albuminuria in adolescents in a region of highly prevalent end-stage renal failure of unknown origin. Clin Kidney J 2022; 15:1300-1311. [PMID: 35756733 PMCID: PMC9217647 DOI: 10.1093/ckj/sfac018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
End-stage renal failure of unknown origin (ESRD-UO) is a public health problem in Mexico and many regions of the world. The prevalence of ESRD-UO in Aguascalientes Mexico is one of the highest worldwide, particularly in adults between 20 and 40 years of age.
Aim
To screen adolescents for chronic kidney disease (CKD), identify risk factors, and histologically characterize adolescents with persistent albuminuria (pACR).
Methodology
This is a cross-sectional, observational, and comparative study of adolescents in whom serum creatinine and the albumin creatinine ratio (ACR) were determined when screening for CKD. A clinical evaluation and risk factor survey were conducted. Patients with an abnormal ACR (≥ 30 mg/gr) or a low glomerular filtration rate (GFR) (≤75 ml/min/1.73 m2) were reevaluated and a renal ultrasound was obtained (rUS). A kidney biopsy was performed in patients with pACR.
Results
Five-hundred and thirteen (513) students were included, 19 had pACR and 494 were controls. The prevalence of pACR was 3.7% (95%CI 2.1 – 5.3). Only one patient had a decreased GRF. None of the patients with pACR had anatomical abnormalities of the urinary tract by rUS. Patients with pACR had a decreased total renal volume in comparison with the control group (150 vs 195 ml/m2, p <0.01). Eighteen (18) kidney biopsies were performed, 72% had glomerulomegaly, and only one patient had mild fibrosis. Podocyte abnormalities were evident on electron microscopy: partial fusion (100%), microvillous degeneration (80%), and increased organelles (60%). Risk factors for pACR were: homestead proximity to maize crops, the use of pesticides at the father´s workplace, a family history of CKD, and blood pressure abnormalities. The body mass index and breastfeeding were protective factors.
Conclusions
The prevalence of pACR in adolescents in Aguascalientes is high, and histologic compromise is characterized by podocyte injury in the absence of fibrosis. The renal volume of pACR patients was decreased, suggesting oligonephronia. Exposure to environmental toxins such as pesticides, even prenatally, may be responsible for this pathological entity. Screening programs in adolescents by determining ACR are necessary in our milieu.
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Affiliation(s)
| | - Myriam del Carmen Corrales Aguirre
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Mexico
- Department of Pediatrics, Hospital Centenario Miguel Hidalgo, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | - Alfredo Chew Wong
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Mexico
| | | | - Rodolfo Delgadillo Castañeda
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Mexico
- Department of Pediatrics, Hospital Centenario Miguel Hidalgo, Mexico
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22
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Nanayakkara N, Medagedara A, Hewavitharane P, Chandrajith R, K. Abeysundara H, Thatil RO, Thennakoon S, Mahanama B, Weerasuriya N, Thilakarathne A. Comparison of biochemical characteristics between an endemic and a nonendemic area for CKDu Sri Lanka. ENVIRONMENTAL DISEASE 2022. [DOI: 10.4103/ed.ed_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Arambegedara D, Jayasinghe S, Udagama P. Multi-pronged research on endemic chronic kidney disease of unknown etiology in Sri Lanka: a systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:4893-4910. [PMID: 34799798 PMCID: PMC8604553 DOI: 10.1007/s11356-021-17316-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/27/2021] [Indexed: 05/08/2023]
Abstract
Increasing prevalence of endemic chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is a major health problem since the 1990s. Despite numerous studies on CKDu, research groups have been unable to develop a comprehensive approach to mitigate the disorder, and thereby to identify research gaps. We conducted a systematic literature review of 119 publications on CKDu in Sri Lanka from Pubmed, Google Scholar, and Scopus, published until end September 2020. A higher CKDu prevalence in the working population of the North Central Province was reported with recent studies indicating patients from non-endemic regions as well. A majority were etiological studies that recorded conflicting and inconclusive evidence on CKDu etiology. Studies on clinico-pathological, diagnostic, biochemical, and molecular biological aspects of CKDu, studies analyzing CKDu symptom burden, anthropological, and behavioral impacts of CKDu, were reviewed as well. A dearth of research exists on nutritional, demographical, immunological, and microbial aspects of CKDu. The overview of the reviewed literature indicated the absence of a comprehensive plan of action to mitigate this situation. Hence, we propose the "One Health" approach with a systems dynamics model as a potential way forward to alleviate the CKDu epidemic in Sri Lanka. This enables the representation of multiple causative agents (and interactions thereof) among environmental, animal, and human systems, in concert with the "exposome" that provides the totality of exposure the individual has undergone since birth.
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Affiliation(s)
- Dinushi Arambegedara
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, 3, Sri Lanka
| | - Saroj Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, 8, Sri Lanka
| | - Preethi Udagama
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, 3, Sri Lanka.
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24
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Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Neelapaichit N, Chittamma A, Kitiyakara C. Women and other risk factors for chronic kidney disease of unknown etiology in Thailand: National Health Examination V Survey. Sci Rep 2021; 11:21366. [PMID: 34725395 PMCID: PMC8560950 DOI: 10.1038/s41598-021-00694-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/12/2021] [Indexed: 12/27/2022] Open
Abstract
There are limited data on chronic kidney disease of unknown etiology (CKDu) from Southeast Asia. Initially described in working age men, a common approach to detect CKDu that includes all adults has recently been proposed. We determined the prevalence, and risk factors for CKDu using data from a cross-sectional, nationally representative survey of the adult population of Thailand. We used a proxy for CKDu as age < 70 with impaired kidney function (eGFR < 60) in the absence of diabetes and hypertension (CKDu1) and heavy proteinuria (CKDu2). Prevalence estimates were probability-weighted for the Thai population. The associations between risk factors and CKDu or elderly subjects with eGFR < 60 without traditional causes were assessed by multivariable logistic regression. Of 17,329 subjects, the prevalence were: eGFR < 60, 5.3%; CKDu1 0.78%; CKDu2, 0.75%. CKDu differed by 4.3-folds between regions. Women, farmers/laborers, older age, gout, painkillers, rural area, and stones were independent risk factors for CKDu. Women, age, rural, gout, painkillers were significant risk factors for both CKDu and elderly subjects. These data collected using standardized methodology showed that the prevalence of CKDu in Thailand was low overall, although some regions had higher risk. Unlike other countries, Thai women had a two-fold higher risk of CKDu.
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Affiliation(s)
- Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pattapong Kessomboon
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Nareemarn Neelapaichit
- Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anchalee Chittamma
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chagriya Kitiyakara
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Abstract
AbstractThe prevalence of chronic kidney disease (CKD) has been on the rise worldwide. Epidemiological studies performed primarily in Central America and South Asia have reported high prevalence of CKD among young and middle-aged men working in agricultural communities. The clinical features do not appear linked to any classical CKD risk factors, such as hypertension, diabetes, or chronic nephritis. The disease develops and progresses as interstitial nephritis, without showing noticeable symptoms or high levels of proteinuria. Pathologically, the disease essentially represents chronic interstitial nephritis and is termed chronic interstitial nephritis in agricultural communities (CINAC). The potential causes of CINAC include: (1) heat stress-related factors associated with increased ambient temperatures resulting from global warming; and (2) factors connected with exposure to agrochemicals and/or pesticides. Global warming and environmental pollution will undoubtedly pose a significant health risk to farmers, and heat stress during farm work could easily result in the development and progression of CKD. Japanese agricultural regions evidently will not be spared from global environmental changes. For future epidemiological studies, researchers should establish a more comprehensive analytical method that can incorporate additional risk-factor variables, such as occupational history (including agricultural work) and ambient temperature.
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Kulasooriya PN, Jayasekara KB, Nisansala T, Kannangara S, Karunarathna R, Karunarathne C, Wikramarathne M, Albert SM. Utility of Self-Reported Heat Stress Symptoms and NGAL Biomarker to Screen for Chronic Kidney Disease of Unknown Origin (CKDu) in Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910498. [PMID: 34639798 PMCID: PMC8507708 DOI: 10.3390/ijerph181910498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/28/2022]
Abstract
Objective. We examined heat stress symptoms and urine markers of chronic kidney disease (CKDu) in Sri Lanka to assess differences between endemic vs. non-endemic regions and by occupation. Sample and Methods. We assessed a total of 475 villagers. In the endemic region, 293 were agricultural workers and 67 were not working primarily in agriculture. In the non-endemic region, 76 were agricultural workers. Of the residents, 218 were assessed for neutrophil gelatinase-associated lipocalin (NGAL), an early predictor of acute kidney injury, along with urine markers of chronic kidney disease. Results. The mean (sd) age of the sample was 45.2 (12.6), with males comprising 52.7%; 7.2% reported kidney disease (n = 34), and 5.7% reported diabetes (n = 27). The heat stress index (mean (sd)) was highest among agricultural workers in the endemic region (8.05 (5.9)), intermediate in non-agricultural workers in the endemic region (4.61 (4.5)), and lowest among agricultural workers in the non-endemic region (3.85 (3.3)); p < 0.0001. Correlations were higher between NGAL and serum microalbumin in the endemic agricultural worker sample than in the other two samples (Spearman’s r = 0.34 vs. 0.15 and 0.20). Conclusions. Both heat stress symptoms and NGAL values were higher among agricultural workers in endemic CKDu regions. Correlations between NGAL and microalbumin suggested a link between acute kidney injury and chronic kidney disease in the more-exposed sample.
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Affiliation(s)
- Pavithra N. Kulasooriya
- University Hospital, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka; (P.N.K.); (T.N.)
- Faculty of Allied Health Sciences, University of Peradeniya, Kandy 20400, Sri Lanka;
| | - Kithsiri B. Jayasekara
- Faculty of Allied Health Sciences, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka; (K.B.J.); (S.K.); (C.K.)
| | - Thilini Nisansala
- University Hospital, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka; (P.N.K.); (T.N.)
- Faculty of Allied Health Sciences, University of Peradeniya, Kandy 20400, Sri Lanka;
| | - Sajani Kannangara
- Faculty of Allied Health Sciences, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka; (K.B.J.); (S.K.); (C.K.)
| | | | - Chaminda Karunarathne
- Faculty of Allied Health Sciences, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka; (K.B.J.); (S.K.); (C.K.)
| | - Mahinda Wikramarathne
- Faculty of Allied Health Sciences, University of Peradeniya, Kandy 20400, Sri Lanka;
| | - Steven M. Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA 15621, USA
- Correspondence:
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Identification of Novel Rodent-Borne Orthohantaviruses in an Endemic Area of Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka. Viruses 2021; 13:v13101984. [PMID: 34696414 PMCID: PMC8539126 DOI: 10.3390/v13101984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 01/25/2023] Open
Abstract
We reported the genetic evidence of circulating hantaviruses from small mammals captured in a chronic kidney disease of unknown etiology (CKDu) hotspot area of Sri Lanka. The high seroprevalence of anti-hantavirus antibodies against Thailand orthohantavirus (THAIV) has been reported among CKDu patients and rodents in Sri Lankan CKDu hotspots. We captured 116 small mammals from CKDu endemic regions in the Polonnaruwa District of Sri Lanka. Seven animals (five out of 11 Mus booduga and two out of 99 Rattus rattus) were PCR-positive for the hantavirus. A rat-borne sequence was grouped with a THAIV-like Anjozorobe virus. In contrast, Mus-borne sequences belonged to the THAIV lineage, suggesting a novel orthohantavirus species according to the phylogenetic analyses and whole-genome comparisons. Our genetic evidence indicates the presence of two THAIV-related viruses circulating in this CKDu endemic area, suggesting a basis for further investigations to identify the infectious virus in patients with CKDu and the CKDu induction mechanism of these viruses.
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28
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Gunawardena S, Dayaratne M, Wijesinghe H, Wijewickrama E. A Systematic Review of Renal Pathology in Chronic Kidney Disease of Uncertain Etiology. Kidney Int Rep 2021; 6:1711-1728. [PMID: 34169213 PMCID: PMC8207327 DOI: 10.1016/j.ekir.2021.03.898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/06/2021] [Accepted: 03/29/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Despite much research on chronic kidney disease of uncertain etiology (CKDu) in Sri Lanka and the Mesoamerican nephropathy, the etiology and pathogenesis of this disease remains elusive. The pathology has broadly been described as chronic tubulointerstitial nephritis and no specific signature lesions have been identified. METHODS A scoping review was conducted through MEDLINE and Google Scholar databases for peer-reviewed publications on biopsy studies related to CKDu - Sri Lanka and Mesoamerican nephropathy to develop a comparative and critical analysis of the renal pathology found in these patients. RESULTS Thirteen studies met the selection criteria. Interstitial fibrosis was the predominant lesion in all the studies. Tubulointerstitial and glomerular abnormalities showed a more variable distribution. No characteristic histopathological feature was reported other than a proximal tubular lysosomal inclusion body which was claimed to indicate a toxic etiology. Three main pathogenetic mechanisms were postulated: repeated acute insults leading to scarring, low-grade chronic insults leading to non-inflammatory fibrosis, and tubulointerstitial damage in combination with glomerular injury. The main limitations in the interpretation and comparative analysis of these studies were the heterogeneity in case selection and biopsy reporting. CONCLUSIONS Although no characteristic histopathological feature could be found in CKDu-Sri Lanka or Mesoamerican nephropathy, there are noticeable differences between these two groups in the frequency and severity of the glomerular and tubulointerstitial changes which warrant more explorative studies preferably on kidneys in early stages of the disease. Future strategies should ensure that more uniform selection criteria and reporting methods are used.
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Affiliation(s)
- Sameera Gunawardena
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Maleesha Dayaratne
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Harshima Wijesinghe
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Optimization of 25% Sulfosalicylic Acid Protein-to-Creatinine Ratio for Screening of Low-Grade Proteinuria. Int J Anal Chem 2021; 2021:6688941. [PMID: 33574847 PMCID: PMC7861924 DOI: 10.1155/2021/6688941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 11/21/2022] Open
Abstract
Proteinuria is an important prognostic marker in the diagnosis and management of kidney diseases. Sulfosalicylic acid method (SSA) is a simple, low cost, qualitative test, widely used to assess proteinuria. The aim of this study was to optimize SSA test as a quantitative screening tool to assess proteinuria at lower excretory levels which would facilitate the screening and early diagnosis of renal impairment using protein-to-creatinine ratio (PCR). The study was conducted in two phases. In phase I, optimum SSA percentage to detect low-grade proteinuria was selected by comparing the performance of 3%, 6%, and 25% SSA methods in manual spectrophotometric analysis. In phase II, clinical applicability of the optimized method was evaluated using retained urine samples of patients with chronic kidney disease (CKD) assessed for urine protein by the pyrogallol red (PGR) method in a tertiary care hospital in Sri Lanka. Optimized 25% SSA protein-to-creatinine ratio (PCR) was compared with PGR PCR and albumin-to-creatinine ratio (ACR). Sensitivity, specificity, degree of agreement, correlation, and diagnostic accuracy were evaluated. Turbidimetric analysis using 25% SSA was linear in the range 3–50 mg/dL giving the highest analytical sensitivity. The test yielded a sensitivity of 86.5% and specificity of 96.5% and a degree of agreement of 5 mg/dL with the PGR method. Optimal cut-off for 25% SSA PCR in receiver operating characteristic analysis was 166 mg/g. Spearman's correlation coefficient for 25% SSA PCR versus ACR was r = 0.823, p < 0.0001, and for 25% SSA PCR versus PGR PCR was r = 0.913, p < 0.0001. The 25% SSA PCR has a sensitivity of 92% against ACR, the current prognostic marker for proteinuria in patients with CKD. The 25% SSA test is a simple method, and it performs satisfactorily as a screening test with a cut-off for PCR optimized at 166 mg/g. The test merits further evaluation due to its low cost.
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30
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Gutierrez-Peña M, Zuñiga-Macias L, Marin-Garcia R, Ovalle-Robles I, García-Díaz AL, Macías-Guzmán MJ, Delgado-Bentites A, Macías-Diaz DM, Prado-Aguilar CA, Vega de la Rosa A, Delgadillo-Castañeda R, Chew-Won A, Reyes-Acevedo R, Reyes-Campos DM, Martínez-Guevara MA, Mendoza-Enciso EA, Nava-Becerra B, Piza-Jiménez MA, Arreola Guerra JM. High prevalence of end-stage renal disease of unknown origin in Aguascalientes Mexico: role of the registry of chronic kidney disease and renal biopsy in its approach and future directions. Clin Kidney J 2021; 14:1197-1206. [PMID: 34094519 PMCID: PMC8173605 DOI: 10.1093/ckj/sfaa229] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Indexed: 01/05/2023] Open
Abstract
Background Chronic kidney disease (CKD) is one of the pathologies with the greatest impact on the public health system. Over the last few decades, the relevance of CKD in Mexico has increased, with associated overwhelming costs for care of renal disease. There are no reliable CKD statistics in Mexico. Methodology In June 2018, the government of Aguascalientes called on all Health Institutions to create a state registry of treated end-stage renal disease (ESRD). In the same system, a renal biopsy result registry included all the native kidney biopsies obtained in the state of Aguascalientes since 2012. We herein describe the prevalence, incidence and characteristics of the patients included in the CKD and renal biopsy registry in the state of Aguascalientes. Results As of April 2020, the state has documented 2827 patients on renal replacement therapy (RRT), 1877 on dialysis and 950 that have been transplanted. The prevalence of patients on dialysis is 1326 per million population (p.m.p.), and if transplanted individuals are included, it is 1997 p.m.p. The incidence of treated ESRD in 2019 was 336 p.m.p. (n = 474) in individuals with an average age of 45.6 years (standard deviation ±18), and in a higher proportion of men (61%). There is a bimodal distribution of the age at which RRT was initiated. The first and the most significant peaks are between the ages of 20 and 40 years and are usually the result of CKD of unknown cause (73%). The second peak is between 50 and 70 years of age, and CKD is usually the result of diabetes mellitus and systemic arterial hypertension (59.6%). Since January 2012, 423 biopsies have been recorded. The patient’s ages were between 20 and 30 years (n = 112), and the most frequent diagnosis was focal segmental glomerulosclerosis (FSGS) (54%). Conclusions The prevalence of treated ESRD in the state of Aguascalientes is high. The disease mostly afflicts young people between 20 and 40 years of age, and there is a clear male predominance. In this age group, the main clinical diagnosis is CKD of unknown origin, and the most frequent biopsy diagnosis was FSGS.
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Affiliation(s)
- Mauricio Gutierrez-Peña
- Aguascalientes Institute of Health Services, Aguascalientes, Mexico.,Department of Internal Medicine, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
| | - Leslie Zuñiga-Macias
- Department of Internal Medicine, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico.,Department of Biological Sciences, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - Ricardo Marin-Garcia
- Aguascalientes Institute of Health Services, Aguascalientes, Mexico.,Instituto Mexicano del Seguro Social, Aguascalientes, Mexico
| | - Itzel Ovalle-Robles
- Department of Internal Medicine, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
| | - Andrea L García-Díaz
- Department of Internal Medicine, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
| | | | | | | | | | | | - Rodolfo Delgadillo-Castañeda
- Aguascalientes Institute of Health Services, Aguascalientes, Mexico.,Department of Transplantation, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
| | - Alfredo Chew-Won
- Department of Internal Medicine, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
| | - Rafael Reyes-Acevedo
- Department of Transplantation, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
| | | | | | | | - Bernardo Nava-Becerra
- Department of Internal Medicine, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico.,Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Gómez Palacio, Mexico
| | | | - José Manuel Arreola Guerra
- Aguascalientes Institute of Health Services, Aguascalientes, Mexico.,Department of Internal Medicine, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
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Redmon JH, Levine KE, Lebov J, Harrington J, Kondash AJ. A comparative review: Chronic Kidney Disease of unknown etiology (CKDu) research conducted in Latin America versus Asia. ENVIRONMENTAL RESEARCH 2021; 192:110270. [PMID: 33035557 DOI: 10.1016/j.envres.2020.110270] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The incidence of chronic kidney disease of unknown or uncertain etiology (CKDu) is recognized as a global non-communicable health crisis. The goal of this work is to compare the types of research studies in Latin America and Asia, two regions with increasing CKDu incidence. METHODS A comparative literature review was conducted to evaluate the CKDu research design for peer-reviewed articles published from 2015 to 2019. Full texts were reviewed to identify study location, study type, study design, risk factors evaluated, and if applicable, sample type and number. RESULTS In Asia and Latin America, 82 and 65 articles were identified in total, respectively, with 55 field studies in Asia versus 34 in Latin America. In Asia, research was focused on drinking water (34), heavy metals (20), and agrochemical product usage (19) as potential risk factors. In Latin America, research focused mostly on heat stress/dehydration (36) and agrochemical product usage (18) as potential CKDu risk factors. Biological samples were collected more frequently than environmental samples, especially in Latin America. DISCUSSION Research to pinpoint the risk factors associated with CKDu to date is not standardized and typically limited in geographical scope. The emphasis of CKDu research varies by geographic region, with a greater priority placed on water quality and chemical exposure in Asia, versus dehydration and heat stress in Latin America. Using a harmonized approach to CKDu research would yield improved understanding of the risk factors associated with CKDu and how they compare across affected regions.
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Affiliation(s)
| | | | - Jill Lebov
- RTI International, Research Triangle Park, NC, USA
| | | | - A J Kondash
- RTI International, Research Triangle Park, NC, USA
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Gunasekara T, De Silva PMC, Herath C, Siribaddana S, Siribaddana N, Jayasumana C, Jayasinghe S, Cardenas-Gonzalez M, Jayasundara N. The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9522. [PMID: 33353238 PMCID: PMC7766480 DOI: 10.3390/ijerph17249522] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 12/25/2022]
Abstract
Chronic Kidney Disease (CKD) is a globally prevalent non-communicable disease with significant mortality and morbidity. It is typically associated with diabetes and hypertension; however, over the last two decades, an emergence of CKD of unknown etiology (CKDu) has claimed thousands of lives in several tropical agricultural communities. CKDu is associated with gradual loss of renal function without initial symptoms until reaching complete kidney failure and eventually death. The most impacted are young adult males of lower socio-economic strata. Since the disease progression can be successfully attenuated through early detection, the development of superior screening and management measures is of utmost importance. In contrast to the conventional biomarkers, novel biomarkers with improved sensitivity and specificity are being discussed as promising tools for early diagnosis of the disease. This review summarizes emerging novel biomarkers used in assessing CKD and discusses the current utility and diagnostic potential of such biomarkers for CKDu screening in clinical settings of different communities impacted by CKDu. Our goal is to provide a framework for practitioners in CKDu impacted regions to consider the use of these novel biomarkers through this synthesis. The increased use of these biomarkers will not only help to validate their diagnostic power further and establish potential prognostic value but may also provide critical insights into sites and mechanisms of renal damage.
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Affiliation(s)
- T.D.K.S.C. Gunasekara
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka;
| | - P. Mangala C.S. De Silva
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka;
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Chula Herath
- Department of Nephrology, Sri Jayawardenapura General Hospital, Sri Jayawardenepura Kotte 10100, Sri Lanka;
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Nipuna Siribaddana
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Sudheera Jayasinghe
- Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Matara 81000, Sri Lanka;
| | - Maria Cardenas-Gonzalez
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Mexican Council of Science and Technology, Consejo Nacional de Ciencia y Tecnología, Mexico City 03940, Mexico
| | - Nishad Jayasundara
- The Nicholas School of the Environment, Duke University, Durham, NC 27708, USA;
- The School of Marine Sciences, University of Maine, Orono, ME 04469, USA
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33
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Abdissa D. Purposeful Review to Identify Risk Factors, Epidemiology, Clinical Features, Treatment and Prevention of Chronic Kidney Disease of Unknown Etiology. Int J Nephrol Renovasc Dis 2020; 13:367-377. [PMID: 33363397 PMCID: PMC7754091 DOI: 10.2147/ijnrd.s283161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
The global burden of chronic kidney disease (CKD) has risen, and chronic kidney disease of unknown etiology (CKDu) contributes considerably to the national burden of CKD. It is characterized by irreversible, slowly advancing disease, and symptoms often appear in the late stages of the disease. It is a serious, novel cause of kidney failure and leads to premature deaths. Many hypotheses have emerged; however, the etiology of CKDu continues to be elusive and debatable and it is claimed that the etiology is multifactorial, encompassing environmental, genetic, occupational, and social factors. The dominant histopathological feature is chronic tubulointerstitial nephritis. It predominantly affects individuals with low socio-economic status, of working age, largely without chronic comorbidities, who perform strenuous labor in extreme conditions in various tropical areas of the world. It is often fatal due to fast progression and limited access to dialysis or transplant options in the involved geographic areas. Early recognition and appropriate interventions at the earliest possible stage are imperative for decreasing its associated morbidity and mortality. In this review, I tried to summarize available evidence on the risk factors, epidemiology, clinical features, treatment, and prevention of CKDu. The literature search for this review was conducted comprehensively by using different electronic databases and by using appropriate search terms.
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Affiliation(s)
- Daba Abdissa
- Department of Biomedical Sciences, College of Medical Science, Institute of Health Science, Jimma University, Jimma, Ethiopia
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34
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Rodrigo C, Nawarathne P, Jayasinghe S. Chronic interstitial nephritis in agricultural communities (CINAC) and lysosomal tubulopathy: Is there a place for anti-oxidants? Med Hypotheses 2020; 146:110414. [PMID: 33268000 DOI: 10.1016/j.mehy.2020.110414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022]
Abstract
Chronic Interstitial Nephritis in Agricultural Communities (CINAC) continues to attract controversy in the scientific community. It was previously known as Chronic Kidney Disease of Unknown Etiology (CKDu) and is not associated with the common aetiological factors such as diabetes. There is general acceptance that it is an environmentally induced disorder due to a combination of toxicities: heavy metals from food, fluoride in drinking water, hard water, heat stress and pesticides. The recent findings of a lysosomal inclusion body tubulopathy is of great interest to those attempting to find therapeutic agents to slow or eliminate its renal damage. The paper argues that despite these new findings, oxidative stress could play a key role and proposes that anti-oxidants such as Vitamin C and E be repurposed for treatment.
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Affiliation(s)
- Chathuri Rodrigo
- Research Assistants, Faculty of Medicine of University of Colombo, Sri Lanka
| | | | - Saroj Jayasinghe
- Professor of Medicine, Faculty of Medicine of University of Colombo, Kynsey Road, Colombo 00800, Sri Lanka.
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35
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Ameh OI, Ekrikpo U, Bello A, Okpechi I. Current Management Strategies of Chronic Kidney Disease in Resource-Limited Countries. Int J Nephrol Renovasc Dis 2020; 13:239-251. [PMID: 33116755 PMCID: PMC7567536 DOI: 10.2147/ijnrd.s242235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/12/2020] [Indexed: 12/12/2022] Open
Abstract
The incidence and prevalence of chronic kidney disease (CKD) and kidney failure continues to increase worldwide, especially in resource-limited countries. Many countries in this category already have a massive burden of communicable diseases, as well as socio-economic and socio-demographic challenges. The rising CKD burden and exorbitant economic cost associated with treatment are mainly responsible for the alarming mortality rate associated with kidney disease in these regions. There is often poor risk factor (diabetes and hypertension) and CKD awareness in these countries and limited availability and affordability of treatment options. Given these observations, early disease detection and preventive measures remain the best options for disease management in resource-limited settings. Primary, secondary and tertiary preventive strategies need to be enhanced and should particularly include measures to increase awareness, regular assessment to detect hypertension, diabetes and albuminuria, options for early referral of identified patients to a nephrologist and options for conservative kidney management where kidney replacement therapies may not be available or indicated. Much is still needed to be done by governments in these regions, especially regarding healthcare funding, improving the primary healthcare systems and enhancing non-communicable disease detection and treatment programs as these will have effects on kidney care in these regions.
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Affiliation(s)
| | - Udeme Ekrikpo
- Renal Unit, Department of Internal Medicine, University of Uyo, Uyo, Nigeria
| | - Aminu Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
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36
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Fernando BNTW, Sudeshika TSH, Hettiarachchi TW, Badurdeen Z, Abeysekara TDJ, Abeysundara HTK, Jayasinghe S, Ranasighe S, Nanayakkara N. Evaluation of biochemical profile of Chronic Kidney Disease of uncertain etiology in Sri Lanka. PLoS One 2020; 15:e0232522. [PMID: 32365131 PMCID: PMC7197770 DOI: 10.1371/journal.pone.0232522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/16/2020] [Indexed: 01/04/2023] Open
Abstract
Chronic Kidney Disease of uncertain etiology (CKDu) is an endemic, disease that mostly affects young agricultural workers in the rural dry zone of Sri Lanka. This study was designed to identify specific biochemical manifestations of CKDu cases. All (119) non-dialysis definite CKDu patients in Girandurukotte and Wilgamuwa were selected. Blood and urine samples were collected and measured biochemical parameters. All analyses were performed in IBM SPSS statistics version 23 (IBM Corp, USA). The median blood pressure was normal though nearly half of the patients (45.4%) who were in the advanced stages (Stage 3b, 4 and 5) of CKDu. Patients without a history of hypertension before the diagnosis of CKDu (100%) and minimal proteinuria (26%) are similar to the previous findings. Patients without a history of diabetes before the CKDu diagnosis had high percentages of diabetes (15.7%) and pre-diabetes (59.8%) and hence indicated the possibility of uremia induced impaired glucose intolerance in the rural areas of the country. There were 62.2% patients who had low vitamin D and only a minority had evidence of bone mineral diseases. Out of liver disease markers serum glutamic pyruvic transaminases (SGPT), serum glutamic oxaloacetic transaminases (SGOT), gamma-glutamyl transferase (GGT), and Lactic acid degydrogenase (LDH) had an inverse correlation with the advancement of the disease indicating subclinical liver disease. Osmolality in serum and urine showed a discrepancy despite > 50% of CKDu patients had increased their serum osmolality. The current study supports most of the previously described manifestations of CKDu. Moreover, some specific patterns have been identified which need to be validated in a larger group.
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Affiliation(s)
- Buddhi N. T. W. Fernando
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
- * E-mail:
| | - Thilini S. H. Sudeshika
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini W. Hettiarachchi
- Faculty of Medicine, Centre for Education, Research and Training on Kidney Diseases (CERTKiD), University of Peradeniya, Peradeniya, Sri Lanka
| | - Zeid Badurdeen
- Faculty of Medicine, Centre for Education, Research and Training on Kidney Diseases (CERTKiD), University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilak D. J. Abeysekara
- Faculty of Medicine, Centre for Education, Research and Training on Kidney Diseases (CERTKiD), University of Peradeniya, Peradeniya, Sri Lanka
| | - Hemalika T. K. Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sakunthala Jayasinghe
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Shirani Ranasighe
- Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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37
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Yang X, Wu H, Li H. Dehydration-associated chronic kidney disease: a novel case of kidney failure in China. BMC Nephrol 2020; 21:159. [PMID: 32366263 PMCID: PMC7199376 DOI: 10.1186/s12882-020-01804-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/12/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Mesoamerican nephropathy (MeN) is a pattern of chronic kidney disease (CKD) prevalent among Central American men who work in agriculture, and its underlying cause has not been elucidated. Currently, experts hypothesize that MeN is related to repeated episodes of occupational heat stress leading to water loss and hence it is also called dehydration-associated CKD. CASE PRESENTATION We report a case of a 40-year-old man, whose first admission to Peking Union Medical College Hospital was due to acute kidney injury (AKI). The clinical and pathological processes were consistent with acute tubular necrosis (ATN). However, after full recovery, CKD developed 1 year later. The second renal biopsy showed characteristics of ischemic renal disease but there was no evidence of vascular disease. It is worth noting that the patient had been taking part in long-distance running without drinking adequate water for years, which would have markedly decrease his renal blood flow. Thus, this patient may have developed chronic dehydration-associated kidney disease sharing the similar etiology of MeN. CONCLUSIONS We report here a case of dehydration-associated CKD in a Chinese patient which shared similar etiology to MeN. Even in non-agricultural areas, this etiology of CKD should be noted to obtain a relevant history and prompt diagnosis.
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Affiliation(s)
- Xinglin Yang
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Haiting Wu
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Hang Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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38
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Balasubramanya S, Stifel D, Horbulyk T, Kafle K. Chronic kidney disease and household behaviors in Sri Lanka: Historical choices of drinking water and agrochemical use. ECONOMICS AND HUMAN BIOLOGY 2020; 37:100862. [PMID: 32097769 DOI: 10.1016/j.ehb.2020.100862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/17/2020] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Abstract
This paper examines whether there are systematic differences in the historical behaviors of households that are affected and unaffected by chronic kidney disease (CKD) in Sri Lanka pertaining to their water source choices, water treatment practices, and agrochemical use. This analysis is motivated by the Sri Lankan government's largest policy response to this epidemic - to encourage communities to switch from untreated well water to publicly provided alternatives. We use recall methods to elicit information on the drinking water source and treatment choices of households over an 18-year period from 2000-2017. Our analysis is based on a survey of 1497 rural ground-water dependent households in the most CKD-affected areas of the 10 districts of Sri Lanka with the highest prevalence of CKD. Our main findings are that (a) households that have ever used a pump to extract (typically deep) drinking water from a household well are more likely to be affected by CKD; (b) we fail to find a relationship between disease status and households' use of buckets to extract (typically shallow) groundwater from their wells; and (c) those who have ever treated their shallow well water by boiling it are less likely to be affected by CKD. We also find that a greater share of CKD affected households historically used agrochemicals, used wells that were geographically removed from surface water sources, and displayed lower proxies of wealth. The implications of these findings are fourfold. First, since the systematic differences in the historical patterns of water sources and treatments used by CKD affected and non-affected households are modest, the sources of water and the treatment practices themselves may not be the sole risk factors in developing CKD. Second, although we find a negative association between boiling water and the probability of CKD, it is not obvious that a public policy campaign to promote boiling water is an appropriate response. Third, the hydrochemistry of deep and shallow well water needs to be better understood in order to shed light on the positive relationship between deep well water and disease status, and on why boiling shallow but not deep well water is associated with a lower probability of CKD. Fourth, there is a need for a deeper understanding of other risk factors and of the efficacy of preventative programs that provide alternative sources of household drinking water.
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Affiliation(s)
- Soumya Balasubramanya
- Economics Research Group, International Water Management Institute-CGIAR, Pelawatte, Western Province, Sri Lanka.
| | - David Stifel
- Economics Research Group, International Water Management Institute-CGIAR, Pelawatte, Western Province, Sri Lanka; Lafayette College, Easton, PA, United States
| | - Ted Horbulyk
- Economics Research Group, International Water Management Institute-CGIAR, Pelawatte, Western Province, Sri Lanka; University of Calgary, Calgary, Alberta, Canada
| | - Kashi Kafle
- Economics Research Group, International Water Management Institute-CGIAR, Pelawatte, Western Province, Sri Lanka
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Abstract
Mesoamerican endemic nephropathy is a type of chronic kidney disease of unknown origin, present in pockets of high prevalence along the Pacific Ocean coast of the Mesoamerican region, from southwest Mexico to Costa Rica. The disease is common in young adult men, most often yet not exclusively from agricultural communities, and with a high mortality rate. Kidney biopsy specimens show primarily tubular atrophy and interstitial fibrosis with some glomerular changes attributed to ischemia. Exposure to agrochemicals, heavy metals or metalloids, intense physical activity under heat stress with dehydration, infections, among other possible causes have been hypothesized as the culprit of the disease. Hypokalemia and hyperuricemia are frequent clinical features. Early diagnosis is key to initiate timely treatment and slow down the progression to end-stage kidney disease. At present, our knowledge about the magnitude of the disease burden imposed by Mesoamerican endemic nephropathy is clearly incomplete and its cause has not been determined. There is a need to implement epidemiologic and mechanistic research projects as well as formal chronic kidney disease and end-stage kidney disease registries in the Mesoamerican region to better understand the real extent of the epidemic, delimit risk populations, and to construct sound public health policy decisions.
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Affiliation(s)
- Ricardo Correa-Rotter
- Departament of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Ramón García-Trabanino
- Hemodialisis Center, San Salvador, El Salvador; Fondo Social de Emergencia para la Salud de Tierra Blanca, Usulután, El Salvador
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40
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Abstract
A significant increase in cases of chronic kidney disease has been observed in the dry zone of Sri Lanka. This unusual chronic kidney disease was first reported in the early 1990s among middle-aged paddy farmers. Considering epidemiologic and histopathologic findings, the disease recently was named chronic interstitial nephritis in agricultural communities (CINAC). Twenty-five years after the first report, CINAC is the most significant public health issue in the paddy farming areas with more than 70,000 estimated patients and many deaths. Histopathologically, this disease is a tubular interstitial nephritis associated with glomerular sclerosis and mild vascular changes. Morphologic and biochemical characteristics of CINAC in Sri Lanka share many similarities with Mesoamerican nephropathy. Certain natural and man-made toxins, heat stress with repeated volume and salt depletion, infections such as hantavirus and leptospirosis, and a genetic origin have been proposed and investigated as possible etiologies, and an association between CINAC and herbicides is widely discussed. Several preventive measures already have been implemented by health authorities in Sri Lanka to minimize nephrotoxin exposure and well hydrate the inhabitants in the disease-endemic region. The impact of these interventions will be watched with anticipation.
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Affiliation(s)
- Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
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41
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Abstract
Chronic kidney disease increasingly is being recognized as an important global public health problem. Interindividual susceptibility to kidney disease is high and likely is dependent on risk modulation through genetics, fetal and early childhood development, environmental circumstances, and comorbidities. Traditionally, the chronic kidney disease burden has been ascribed largely to hypertension and diabetes. Increasingly, evidence is accumulating that nontraditional risk factors may predominate in some regions and populations, contributing to epidemics of kidney disease. Such nontraditional risk factors include environmental exposures, traditional medicines, fetal and maternal factors, infections, kidney stones, and acute kidney injury. Genetic factors may predispose patients to chronic kidney disease in some populations. Chronic kidney disease of unknown origin has its epicenters in Central America and South Asia. Such clustering of CKD may represent either genetic or environmentally driven kidney disease, or combinations of both. Developmental conditions impacting kidney development often are related to poverty and structural factors that persist throughout life. In this article, we explore the possibilities that genetic and developmental factors may be important contributors to the epidemics in these regions and suggest that optimization of factors impacting kidney development hold promise to reduce the risk of kidney disease in future generations.
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Affiliation(s)
- David Friedman
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Valerie A Luyckx
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Institute for Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.
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Perera T, Ranasinghe S, Alles N, Waduge R. Experimental rat model for acute tubular injury induced by high water hardness and high water fluoride: efficacy of primary preventive intervention by distilled water administration. BMC Nephrol 2020; 21:103. [PMID: 32204690 PMCID: PMC7092545 DOI: 10.1186/s12882-020-01763-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/12/2020] [Indexed: 12/27/2022] Open
Abstract
Background High water hardness associated with high water fluoride and the geographical distribution of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka are well correlated. We undertook this study to observe the effects of high water hardness with high fluoride on kidney and liver in rats and efficacy of distilled water in reducing the effects. Methods Test water sample with high water hardness and high fluoride was collected from Mihinthale region and normal water samples were collected from Kandy region. Twenty-four rats were randomly divided into 8 groups and water samples were introduced as follows as daily water supply. Four groups received normal water for 60 (N1) and 90 (N2) days and test water for 60 (T1) and 90 (T2) days. Other four groups received normal (N3) and test (T3) water for 60 days and followed by distilled water for additional 60 days and normal (N4) and test (T4) water for 90 days followed by distilled water for another 90 days. The rats were sacrificed following treatment. Serum samples were subjected to biochemical tests; serum creatinine, urea, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and elemental analysis. Histopathological examinations were carried out using kidney and liver samples. Results Test water treated groups were associated with acute tubular injury with loss of brush border and test water followed with distilled water treated groups maintained a better morphology with minimal loss of brush border. Serum creatinine levels in T1 and T2 groups and urea level in T2 group were significantly (p < 0.05) increased compared to control groups. After administration of distilled water, both parameters were significantly reduced in T4 group (p < 0.05) compared to T2. Serum AST activity was increased in T4 group (p < 0.05) compared to control group with no histopathological changes in liver tissues. The serum sodium levels were found to be much higher compared to the other electrolytes in test groups. Conclusion Hard water with high fluoride content resulted in acute tubular injury with a significant increase in serum levels of creatinine, urea and AST activity. These alterations were minimized by administering distilled water.
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Affiliation(s)
- Thanusha Perera
- Postgraduate Institute of Science, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Shirani Ranasinghe
- Postgraduate Institute of Science, University of Peradeniya, Peradeniya, Sri Lanka. .,Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Neil Alles
- Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Roshitha Waduge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Muiru AN, Charlebois ED, Balzer LB, Kwarisiima D, Elly A, Black D, Okiror S, Kabami J, Atukunda M, Snyman K, Petersen M, Kamya M, Havlir D, Estrella MM, Hsu CY. The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study. PLoS One 2020; 15:e0229649. [PMID: 32130245 PMCID: PMC7055898 DOI: 10.1371/journal.pone.0229649] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/11/2020] [Indexed: 12/19/2022] Open
Abstract
Background Chronic kidney disease (CKD) may be common among individuals living in sub-Saharan Africa due to the confluence of CKD risk factors and genetic predisposition. Methods We ascertained the prevalence of CKD and its risk factors among a sample of 3,686 participants of a population-based HIV trial in rural Uganda and Kenya. Prevalent CKD was defined as a serum creatinine-based estimated glomerular filtration rate <60 mL/min/1.73m2 or proteinuria (urine dipstick ≥1+). We used inverse-weighting to estimate the population prevalence of CKD, and multivariable log-link Poisson models to assess the associations of potential risk factors with CKD. Results The estimated CKD prevalence was 6.8% (95% CI 5.7–8.1%) overall and varied by region, being 12.5% (10.1–15.4%) in eastern Uganda, 3.9% (2.2–6.8%) in southwestern Uganda and 3.7% (2.7–5.1%) in western Kenya. Risk factors associated with greater CKD prevalence included age ≥60 years (adjusted prevalence ratio [aPR] 3.5 [95% CI 1.9–6.5] compared with age 18–29 years), HIV infection (aPR 1.6 [1.1–2.2]), and residence in eastern Uganda (aPR 3.9 [2.6–5.9]). However, two-thirds of individuals with CKD did not have HIV, diabetes, or hypertension as risk factors. Furthermore, we noted many individuals who did not have proteinuria had dipstick positive leukocyturia or hematuria. Conclusion The prevalence of CKD is appreciable in rural East Africa and there are considerable regional differences. Conventional risk factors appear to only explain a minority of cases, and leukocyturia and hematuria were common, highlighting the need for further research into understanding the nature of CKD in sub-Saharan Africa.
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Affiliation(s)
- Anthony N. Muiru
- University of California, San Francisco, California, United States of America
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
- * E-mail:
| | - Edwin D. Charlebois
- University of California, San Francisco, California, United States of America
| | - Laura B. Balzer
- University of Massachusetts, Amherst, Massachusetts, United States of America
| | | | - Assurah Elly
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Doug Black
- University of California, San Francisco, California, United States of America
| | - Samuel Okiror
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Katherine Snyman
- University of California, San Francisco, California, United States of America
| | - Maya Petersen
- School of Public Health, University of California, Berkeley, California, United States of America
| | | | - Diane Havlir
- University of California, San Francisco, California, United States of America
| | - Michelle M. Estrella
- University of California, San Francisco, California, United States of America
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
| | - Chi-yuan Hsu
- University of California, San Francisco, California, United States of America
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44
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[Hantavirus infection as a risk for chronic kidney disease of unknown etiology (CKDu) in Sri Lanka]. Uirusu 2020; 70:175-184. [PMID: 34544932 DOI: 10.2222/jsv.70.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Chronic kidney disease of unknown etiology (CKDu) has emerged in endemic areas of Sri Lanka since the 1990s. The disease is a chronic but fatal disease. Until now, heavy metals and agrochemicals have been suspected as the cause of CKDu, but it has been still unknown. Recently, we have found a high seroprevalence to hantavirus in CKDu patients and reported that hantavirus infection is a risk of CKDu. Hantaviruses are rodent-borne zoonotic viruses. Here, I would like to introduce a story of the research from sero-epidemiology to the search for host animals.
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45
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Kafle K, Balasubramanya S, Horbulyk T. Prevalence of chronic kidney disease in Sri Lanka: A profile of affected districts reliant on groundwater. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 694:133767. [PMID: 31756806 DOI: 10.1016/j.scitotenv.2019.133767] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/03/2019] [Accepted: 08/03/2019] [Indexed: 05/24/2023]
Abstract
This analysis provides new estimates of chronic kidney disease (CKD) prevalence - including CKD of unknown etiology (CKDu) - across ten districts most affected by CKD in Sri Lanka, including an examination of rural households' historical reliance on groundwater consumption. A carefully designed household survey provides information on whether these households self-reported having a member in the decade prior to 2018, who had been clinically diagnosed with CKD. Households were classified according to whether or not they had used groundwater (from household wells, agro-wells or springs) as their primary source for drinking or cooking for at least five years between 1999 and 2018. More than 98% of households reported having consumed groundwater as their primary source of drinking or cooking water for at least five of those years and >15% of households reported having at least one CKD-affected member in the ten-year period up to 2018, but these numbers varied across and within districts. The reported characteristics of symptomatic individuals reveal that the incidence of CKD was significantly higher among females (62%) than males (38%). In addition to CKD, about 63% of symptomatic individuals had hypertension and about one-third of them also had diabetes. About 33% of the symptomatic individuals had neither diabetes nor hypertension, where this group most closely fits commonly used definitions of CKDu. With a survey response of over 8000 households comprising as many as 30,000 individuals, these data illustrate the scale of CKD in the most-affected districts of Sri Lanka on an aggregate basis as well as revealing differences across districts and at the sub-district level.
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Affiliation(s)
- Kashi Kafle
- International Water Management Institute (IWMI), 127 Sunil Mawatha, Battaramulla, Colombo, Sri Lanka.
| | - Soumya Balasubramanya
- International Water Management Institute (IWMI), 127 Sunil Mawatha, Battaramulla, Colombo, Sri Lanka.
| | - Ted Horbulyk
- International Water Management Institute (IWMI), 127 Sunil Mawatha, Battaramulla, Colombo, Sri Lanka; University of Calgary, Canada.
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46
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Vervaet BA, Nast CC, Jayasumana C, Schreurs G, Roels F, Herath C, Kojc N, Samaee V, Rodrigo S, Gowrishankar S, Mousson C, Dassanayake R, Orantes CM, Vuiblet V, Rigothier C, D'Haese PC, De Broe ME. Chronic interstitial nephritis in agricultural communities is a toxin-induced proximal tubular nephropathy. Kidney Int 2019; 97:350-369. [PMID: 31892415 DOI: 10.1016/j.kint.2019.11.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/09/2019] [Accepted: 10/10/2019] [Indexed: 12/16/2022]
Abstract
Almost 30 years after the detection of chronic interstitial nephritis in agricultural communities (CINAC) its etiology remains unknown. To help define this we examined 34 renal biopsies from Sri Lanka, El Salvador, India and France of patients with chronic kidney disease 2-3 and diagnosed with CINAC by light and electron microscopy. In addition to known histopathology, we identified a unique constellation of proximal tubular cell findings including large dysmorphic lysosomes with a light-medium electron-dense matrix containing dispersed dark electron-dense non-membrane bound "aggregates". These aggregates associated with varying degrees of cellular/tubular atrophy, apparent cell fragment shedding and no-weak proximal tubular cell proliferative capacity. Identical lysosomal lesions, identifiable by electron microscopy, were observed in 9% of renal transplant implantation biopsies, but were more prevalent in six month (50%) and 12 month (67%) protocol biopsies and in indication biopsies (76%) of calcineurin inhibitor treated transplant patients. The phenotype was also found associated with nephrotoxic drugs (lomustine, clomiphene, lithium, cocaine) and in some patients with light chain tubulopathy, all conditions that can be directly or indirectly linked to calcineurin pathway inhibition or modulation. One hundred biopsies of normal kidneys, drug/toxin induced nephropathies, and overt proteinuric patients of different etiologies to some extent could demonstrate the light microscopic proximal tubular cell changes, but rarely the electron microscopic lysosomal features. Rats treated with the calcineurin inhibitor cyclosporine for four weeks developed similar proximal tubular cell lysosomal alterations, which were absent in a dehydration group. Overall, the finding of an identical proximal tubular cell (lysosomal) lesion in CINAC and calcineurin inhibitor nephrotoxicity in different geographic regions suggests a common paradigm where CINAC patients undergo a tubulotoxic mechanism similar to calcineurin inhibitor nephrotoxicity.
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Affiliation(s)
| | - Cynthia C Nast
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Channa Jayasumana
- Faculty of Medicine, Rajatrata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Gerd Schreurs
- Laboratory of Pathophysiology, University Antwerp, Antwerp, Belgium
| | - Frank Roels
- Department of Pathology, Ghent University, Gent, Belgium
| | - Chula Herath
- Department of Nephrology, Sri Jayewardenepura General Hospital, Colombo, Sri Lanka
| | - Nika Kojc
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vahid Samaee
- Electron Microscopy for Materials Science (EMAT), University of Antwerp, Antwerp, Belgium
| | - Sonali Rodrigo
- Department of Nephrology, Sri Jayewardenepura General Hospital, Colombo, Sri Lanka
| | | | - Christiane Mousson
- Department of Nephrology, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | | | - Carlos M Orantes
- National Institute of Health, Ministry of Health of El Salvador, San Salvador, El Salvador
| | - Vincent Vuiblet
- Departments of Nephrology and Renal Pathology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Claire Rigothier
- Service Néphrologie, Transplantation, Dialyse et Aphérèses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Marc E De Broe
- Laboratory of Pathophysiology, University Antwerp, Antwerp, Belgium.
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47
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Kulathunga MRDL, Ayanka Wijayawardena MA, Naidu R, Wijeratne AW. Chronic kidney disease of unknown aetiology in Sri Lanka and the exposure to environmental chemicals: a review of literature. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:2329-2338. [PMID: 30815780 DOI: 10.1007/s10653-019-00264-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 02/10/2019] [Indexed: 06/09/2023]
Abstract
Chronic kidney disease of unknown aetiology (CKDu) has emerged as a serious health issue in Sri Lanka. The disease has been recorded in the North Central Province of the country. While studies have elicited many hypotheses concerning the pathogenicity of CKDu, none adequately explains the cause of CKDu and the measures needed to minimise its occurrence. Nephrotoxic heavy metal (oid)s such as cadmium, arsenic, lead, and chromium are present in biological samples of people from endemic areas. This review appraises evidence on the effects of long-term exposure to low concentration of nephrotoxic heavy metals, which could be the principal cause of CKDu. Although a considerable variation exists in metal concentrations in patients' blood and urine, higher levels of heavy metals were consistently observed in affected areas. This review finds that the populations in the endemic areas are exposed to heavy metal (oid)s at low concentrations, which are considered as safe levels; nevertheless, it influences the incidence of CKDu. Recent global studies on chronic kidney disease (CKD) revealed a low concentration of heavy metals in diseased patients. Research findings indicated that CKDu patients in Sri Lanka demonstrated similar blood levels of Cd, Pb, and higher concentrations of Cr than that have been reported globally. Further studies on the influence of combinations of nephrotoxic heavy metals at low concentrations on reduced glomerular filtration rate and other renal biomarkers could explain CKDu pathogenicity.
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Affiliation(s)
- M R D L Kulathunga
- Global Centre for Environmental Remediation, The University of Newcastle, Callaghan, 2308, Australia
- Fruit Research and Development Institute, Kananwila, Horana, Sri Lanka
| | - M A Ayanka Wijayawardena
- Global Centre for Environmental Remediation, The University of Newcastle, Callaghan, 2308, Australia.
| | - Ravi Naidu
- Global Centre for Environmental Remediation, The University of Newcastle, Callaghan, 2308, Australia
| | - A W Wijeratne
- Faculty of Agricultural Sciences, Sabaragamuwa University of Sri Lanka, Balangoda, Sri Lanka
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48
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Gowrishankar S, Koshy P, Mathew M, Gopalakrishnan N, Kumar VS, Abraham G. Pathology of Uddanam Endemic Nephropathy. Indian J Nephrol 2019; 30:253-255. [PMID: 33273789 PMCID: PMC7699660 DOI: 10.4103/ijn.ijn_363_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/28/2019] [Accepted: 05/07/2019] [Indexed: 11/04/2022] Open
Abstract
In the last decade, pockets of endemic nephropathy have been recognized worldwide, in regions of Central America, Sri Lanka, and India. In India, the nephropathy has been recognized in the Uddanam area of north Andhra Pradesh and has been termed the Uddanam endemic nephropathy (UEN). The disease is distinctive in that besides the geographic distribution, it affects rural populations engaged in farm labor and agriculture, often silent in the initial phase with most patients presenting with advanced renal failure. The renal biopsy findings in all geographic areas including UEN have been one of a chronic tubulointerstitial nephritis with varying degrees of tubular injury, interstitial inflammation, tubular atrophy, and interstitial fibrosis with nonspecific glomerular obsolescence and lack of immune deposits. More recently, the demonstration of dysmorphic lysosomes in renal biopsies has favored a toxic etiology. There are thus many gaps in the understanding of this serious disease prevalent among poorer populations.
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Affiliation(s)
| | - Priyanka Koshy
- Department of Pathology, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - Milly Mathew
- Department of Nephrology, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - N Gopalakrishnan
- Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India
| | - V Siva Kumar
- Department of Nephrology, Sri Venkateshwara Institute of Medical Sciences, Tirupathi, Andra Pradesh, India
| | - Georgi Abraham
- Department of Nephrology, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
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49
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Stalin P, Purty AJ, Abraham G. Distribution and Determinants of Chronic Kidney Disease of Unknown Etiology: A Brief Overview. Indian J Nephrol 2019; 30:241-244. [PMID: 33273787 PMCID: PMC7699663 DOI: 10.4103/ijn.ijn_313_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/25/2018] [Accepted: 01/02/2019] [Indexed: 12/21/2022] Open
Abstract
Globally, 33187000 DALYs and 956000 deaths are attributed to chronic kidney disease (CKD) every year. Diabetes and hypertension are the two most common causes of CKD. Another category of CKD without any known common causes, chronic kidney disease of unknown etiology (CKDu) is also increasingly reported from different regions of the world such as Central America, Sri Lanka, and India. They are predominately observed in agricultural communities where crops such as sugarcane and coconut are commonly cultivated. Young adults and males are at higher risk of developing CKDu. It mainly affects individuals belonging to lower socioeconomic status. Exposure to silica, arsenic, and fluoride might be associated with increased prevalence of CKDu. The role of heat stress in contributing to CKD through dehydration is unclear but cannot be ruled out. Mycotoxins such as aflatoxins and ochratoxins are also found to be associated with CKDu in some settings. Several studies have reported that CKDu has a significant positive association with pesticides used in agriculture such as HCH, Endosulfan, Alachlor, and Pendimethalin. There is also a possible role of infections by Hantavirus and Leptospirosis in acute febrile phase of CKDu. However, there is no conclusive evidence from studies conducted on CKDu regarding its causes and risk factors. Therefore, large-scale studies with better methodology need to be conducted to study the etiology and pathogenesis of CKDu in various settings.
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Affiliation(s)
- P Stalin
- Departments of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Anil J Purty
- Departments of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Georgi Abraham
- Department of General Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
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50
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Jayasekara K, Kulasooriya P, Wijayasiri K, Rajapakse E, Dulshika D, Bandara P, Fried L, De Silva A, Albert S. Relevance of heat stress and dehydration to chronic kidney disease (CKDu) in Sri Lanka. Prev Med Rep 2019; 15:100928. [PMID: 31304082 PMCID: PMC6603435 DOI: 10.1016/j.pmedr.2019.100928] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/25/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022] Open
Abstract
Chronic kidney disease in the absence of hypertension and diabetes is a growing problem among agricultural laborers in tropical and subtropical regions. It is unclear if heat stress and dehydration are risk factors for this form of chronic kidney disease (CKDu). To investigate this relationship, agricultural workers in four villages (n = 261) in North Central Province, Sri Lanka completed the US National Institute for Occupational Safety and Health (NIOSH) health hazard evaluation of heat stress, translated into Sinhalese (July 2017). We constructed a heat stress/dehydration index based on the frequency of 16 symptoms (range 0-32; reliability, 0.84). Workers provided a urine sample for dipstick assessment of urine albumin-creatinine ratio (ACR) and refractometer analysis of urine concentration. Of 261 respondents, 41 participants reported diabetes or chronic kidney disease. They scored higher on the heat stress-dehydration index (10.78 vs. 8.03, p < .01) and were more likely to have ACR > 30 (85.4% vs. 69.4%, p < .05). Among 216 non-pregnant agricultural workers without diabetes or kidney disease (mean age, 46.6; 37% male), villagers in the high-CKDu prevalence area were more likely to show signs of dehydration (for example, greater urine concentration, 1.015 vs. 1.012, p < .05, among males); however, the heat stress-dehydration index overall was not associated with ACR or urine concentration. Because an elevated ACR (proteinuria) is not a reliable marker of early CKDu, additional studies are needed to assess the association between heat stress-dehydration symptoms and risk of CKDu.
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Affiliation(s)
- K.B. Jayasekara
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Sir John Kotelawala Defense University, Sri Lanka
| | - P.N. Kulasooriya
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Sir John Kotelawala Defense University, Sri Lanka
| | - K.N. Wijayasiri
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Sir John Kotelawala Defense University, Sri Lanka
| | - E.D. Rajapakse
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Sir John Kotelawala Defense University, Sri Lanka
| | - D.S. Dulshika
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Sir John Kotelawala Defense University, Sri Lanka
| | - Palitha Bandara
- Provincial Director's Office of Health, North Central Province, Anuradhapura, Sri Lanka
| | - L.F. Fried
- Division of Renal-Electrolyte, School of Medicine, University of Pittsburgh and VA Pittsburgh Healthcare System, USA
| | - A. De Silva
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, USA
| | - S.M. Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, USA
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