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Dheerasekara K, Tharanga R, Rajamanthri L, Wazil A, Nanayakkara N, Muthugala R. The pattern of cytomegalovirus replication in post-renal transplant recipients with pre-emptive therapy strategy during the 1 st year of post-transplantation. Int J Health Sci (Qassim) 2023; 17:39-44. [PMID: 37692991 PMCID: PMC10484063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Objectives The prevalence and reactivating pattern of cytomegalovirus (CMV) among renal transplant recipients in Sri Lanka is scarce. The study was aimed to describe the replication patterns of CMV in post-renal transplant recipients who were on pre-emptive therapy and identify the risk factors and time period for CMV reactivating during the 1st year of transplantation and provide an insight into the selection of pre-emptive therapy in the local setting. Methods A retrospective and cohort study was conducted, enrolling renal transplant recipients who have completed routine 1-year follow-up for pre-emptive management at the National Hospital, Kandy, from January 2016 to January 2021. CMV quantitative polymerase chain reaction results and demographic data of enrolled recipients were analyzed to investigate the CMV replication pattern and risk factors. Categorical data were analyzed using Pearson's Chi-square test, considering P < 0.05 statistically significant. Continuous variables were presented as percentages. Results Two hundred and fifty-one renal transplant recipients' data were included in the study. Of them, 75.70% were male patients, and the mean age of the study population was 43.25 years. CMV DNAemia incidence was 56.57% during the 1st year of post-renal transplantation. Only 9.16% had developed more than 104 IU/mL or significant DNAemia. Sex and donor type were not risk factors for CMV reactivation. However, the recipient's age was significantly associated with CMV viraemia among renal transplant recipients. Conclusion Considering the low incidence of significant viraemia among the study population, pre-emptive treatment would be the cost-effective strategy for management of the post-renal transplant recipients in local settings.
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Affiliation(s)
- Kalpa Dheerasekara
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka
| | - Rekshi Tharanga
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka
| | | | - Abdul Wazil
- Nephrology and Transplant Unit, National Hospital Kandy, Sri Lanka
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Premarathne SS, Gamage C, Chandrajith R, Ratnatunge NV, Wijetunge S, Wazil A, Chou LF, Ko YC, Huang CT, Yang HY, Fonseka A, Sonnadara T, Herath D, Hewavitharane P, Yang CW, Nanayakkara N. Leptospirosis: A Potential Culprit for Chronic Kidney Disease of Uncertain Etiology. Nephron Clin Pract 2023; 147:510-520. [PMID: 36809758 PMCID: PMC10568603 DOI: 10.1159/000528703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/23/2022] [Indexed: 02/23/2023] Open
Abstract
PURPOSE Chronic kidney disease of uncertain etiology (CKDu) is an environmental nephropathy in which the etiological factors are yet uncertain. Leptospirosis, a spirochetal infection that is common among agricultural communities, has been identified as a potential etiology for CKDu beyond environmental nephropathy. Although CKDu is a chronic kidney disease, in endemic regions, an increasing number of cases are reported with features suggestive of acute interstitial nephritis without any known reason (AINu), with or without background CKD. The study hypothesizes that exposure to pathogenic leptospires is one of the causative factors for the occurrence of AINu. METHOD This study was carried out using 59 clinically diagnosed AINu patients, 72 healthy controls from CKDu endemic region (endemic controls [ECs]), and 71 healthy controls from CKDu non-endemic region (non-endemic controls [NECs]). RESULTS The seroprevalence of 18.6, 6.9, and 7.0% was observed in the AIN (or AINu), EC, and NEC groups, respectively, from the rapid IgM test. Among 19 serovars tested, the highest seroprevalence was observed at 72.9, 38.9, and 21.1% in the AIN (AINu), EC, and NEC groups, respectively, by microscopic agglutination test (MAT), particularly for serovar Leptospira santarosai serovar Shermani. This emphasizes the presence of infection in AINu patients, and this also suggests that Leptospira exposure might play an important role in AINu. CONCLUSION These data suggest that exposure to Leptospira infection could be one of the possible causative factors for the occurrence of AINu, which may lead to CKDu in Sri Lanka.
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Affiliation(s)
- Shakila Sudarshani Premarathne
- Centre for Research, National Hospital, Kandy, Sri Lanka
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Chandika Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Rohana Chandrajith
- Depatment of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | | | - Sulochana Wijetunge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Abdul Wazil
- Nephrology and Kidney Transplant Unit, National Hospital, Kandy, Sri Lanka
| | - Li-Fang Chou
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yi-Ching Ko
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | | | - Huang-Yu Yang
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Amanda Fonseka
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | | | | | | | - Chih-Wei Yang
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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ERANDIKA N, Basnayake D, Nayanamali A, Kandane-Rathnayake R, Wazil A, Shanthi A, Nanayakkara N. POS-510 EFFECTIVENESS OF IMMUNOSUPPRESSIVE DRUG COMBINATION TREATMENTS ON DISEASE ACTIVITY IN LUPUS NEPHRITIS PATIENTS IN SRI LANKA. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Fernando BN, Alli-Shaik A, Hemage RK, Badurdeen Z, Hettiarachchi TW, Abeysundara HT, Abeysekara TD, Wazil A, Rathnayake S, Gunaratne J, Nanayakkara N. Pilot Study of Renal Urinary Biomarkers for Diagnosis of CKD of Uncertain Etiology. Kidney Int Rep 2019; 4:1401-1411. [PMID: 31701049 PMCID: PMC6829189 DOI: 10.1016/j.ekir.2019.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/18/2019] [Accepted: 07/15/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Chronic kidney disease of uncertain etiology (CKDu), an emerging chronic kidney disease (CKD) subtype, contributes to significant morbidity and mortality in certain tropical countries. Although several indicators of CKDu have been previously suggested, sensitive and specific tests to detect early disease or predict disease progression are currently unavailable. This study focused on evaluating 8 renal urinary markers, namely neutrophil gelatinase-associated lipocalin (NGAL), Kidney Injury Molecule-1 (KIM1), cystatin C (CST3), beta 2 microglobulin (B2M), osteopontin (OPN), alpha 1 microglobulin (A1M), tissue inhibitor of metalloproteinase 1 (TIMP1), and retinol binding protein 4 (RBP4), with the hypothesis that these have distinct expression patterns in patients with CKDu. Methods A cross-sectional study was conducted with 5 study groups comprising subjects from CKDu, endemic CKD, nonendemic CKD, and endemic healthy and nonendemic healthy controls. The urinary levels of the 8 selected renal biomarkers were quantified using multiplex biomarker assay, and the data were subjected to systematic analysis using logistic regression algorithm aiming to extract the best marker combination that could distinctly identify the disease groups noninvasively from the healthy controls. Results A 3-marker signature panel comprising A1M, KIM1, and RBP4 was identified to represent the best minimum marker combination for differentiating all CKD categories, including CKDu, from healthy controls with an overall sensitivity of ≥0.867 and specificity ≥0.765. The marker combination comprising OPN, KIM1, and RBP4 showed high predictive performance for distinguishing patients with CKDu from patients with CKD with both sensitivity and specificity ≥0.93, which was superior to any existing noninvasive indicator. Conclusion In all, our systematic evaluation of urinary markers previously linked to CKD, in general, allowed identification of exclusive marker panel combination for early diagnosis and confirmation of CKDu.
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Affiliation(s)
- Buddhi N.T.W. Fernando
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Sri Lanka
| | | | - Rusiru K.D. Hemage
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Zeid Badurdeen
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Thilini W. Hettiarachchi
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Hemalika T.K. Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Sri Lanka
| | - Thilak D.J. Abeysekara
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Abdul Wazil
- Transplant and Dialysis Unit, Teaching Hospital, Kandy, Sri Lanka
| | | | - Jayantha Gunaratne
- Institute of Molecular and Cell Biology, Proteos, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nishantha Nanayakkara
- Transplant and Dialysis Unit, Teaching Hospital, Kandy, Sri Lanka
- Correspondence: Nishantha Nanayakkara, Transplant and Dialysis Unit, Teaching Hospital, Kandy 20000, Sri Lanka.
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Basnayake D, Wazil A, Nanayakkara N, Mahanama B, Ratnatunga N, Dissanayake K, Priyadarshana P. SP166A RETROSPECTIVE STUDY ON CLINICAL AND HISTOLOGICAL PATTERN OF PRESENTATION IN LUPUS NEPHRITIS PATIENTS - A SINGLE CENTRE EXPERIENCE IN SRI LANKA. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Duminda Basnayake
- No 315, Williumgopallawa Road, Suduhumpola, Kandy, Sri Lanka, Sri Lanka
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Rope R, Nanayakkara N, Wazil A, Dickowita S, Abeyeskera R, Gunerathne L, Adoosoriya D, Karunasena N, Rathnayake C, Anand S, Saxena A. Expanding CAPD in Low-Resource Settings: A Distance Learning Approach. Perit Dial Int 2018; 38:343-348. [PMID: 29793981 DOI: 10.3747/pdi.2017.00251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/28/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite growing need, treatment for end-stage renal disease is limited in low- and middle-income countries due to resource restraints. We describe the development of an educational curriculum and quality improvement program to support continuous ambulatory peritoneal dialysis (CAPD) performed primarily by non-nephrology providers in Sri Lanka. METHODS We developed a program of education, outcome tracking, and expert consultation to support providers in Kandy, Sri Lanka. Education included videos and in-person didactics covering core topics in CAPD. Event-tracking sheets recorded root causes and management of infections and hospitalizations. Conferences reviewed clinical cases and overall clinic management. We evaluated the patient census, peritonitis rates, and root causes and management of infections over 1 year. RESULTS The curriculum was published through the International Society of Nephrology online academy. High provider turnover limited curriculum assessments. The CAPD patient census rose from 63 to 116 during the year. The peritonitis rate declined significantly, from 0.8 episodes per patient-year in the first 6 months to 0.4 in the latter 6 months, though the most common root causes of peritonitis, related to contamination events and hygiene, persisted. The appropriate ascertainment of culture data and prescription of antibiotics also increased. CONCLUSIONS Our project supported the expansion of a CAPD program in a resource-limited setting, while also improving peritonitis outcomes. Ongoing challenges include ensuring a durable educational system for rotating providers, tracking outcomes beyond peritonitis, and formalizing management protocols. Our program can serve as an example of how established dialysis programs can support the burgeoning work of providers in resource-limited setting.
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Affiliation(s)
- Robert Rope
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | | | | | | | | | | | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Anjali Saxena
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA.,Division of Nephrology, Santa Clara Valley Medical Center, San Jose, CA, USA
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Herath N, Ratnatunga N, Weerakoon K, Wazil A, Nanayakkara N. Clinicopathological findings, treatment response and predictors of long-term outcome in a cohort of lupus nephritis patients managed according to the Euro-lupus regime: a retrospective analysis in Sri Lanka. BMC Res Notes 2017; 10:80. [PMID: 28148285 PMCID: PMC5288939 DOI: 10.1186/s13104-017-2402-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 01/24/2017] [Indexed: 11/18/2022] Open
Abstract
Background Despite the improvement in survival of patients with lupus nephritis (LN) globally, there is sparse data from Sri Lanka (SL). The current study aims to describe the clinicopathological findings, treatment response and predictors of long-term outcome of patients with WHO class III–IV LN in SL, managed according to the Euro-lupus regime. Results Of 72 patients, 64 were females. In half of them, LN was diagnosed within the 1st year of the illness. The most common presenting feature was sub-nephrotic proteinuria. Sixteen and twenty patients had nephrotic syndrome and abnormal renal function respectively at the time of diagnosis. Fifty-four patients (75%) responded to the Euro-lupus regimen [CR, 20 (28%); PR, 34(47%)]. Later at 6 months, 65 patients (90%) achieved remission [CR, 31(43%); PR, 34 (47%)]. Seven patients experienced treatment failure. During the total duration of follow up, 54 patients remained in complete or partial remission, 26 developed renal relapses, and 19 suffered severe infective episodes. Renal relapses were more common in people who achieved partial remission than complete remission. The long term renal outcome was not associated with age, sex, severity of proteinuria, class of LN or initial renal function. Patients who achieved remission at 6 months had a good long-term outcome. Conclusions The demographic and clinical features of WHO class III and IV LN in Sri Lankan patients were similar to that reported in the global literature. 75% of patients responded to the Euro-lupus regimen. Therefore, this regime is a suitable initial regimen for LN patients in SL. Good long-term renal outcome can be predicted by early response to therapy. Further studies are necessary to explore better treatment options for patients who fail to achieve remission during initial therapy.
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Affiliation(s)
- Nalaka Herath
- Nephrology Unit, Teaching Hospital, Karapitiya, Galle, Sri Lanka.
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kosala Weerakoon
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Abdul Wazil
- Nephrology Unit, Teaching Hospital, Kandy, Sri Lanka
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Herath NJ, Kularatne SAM, Weerakoon KGAD, Wazil A, Subasinghe N, Ratnatunga NVI. Long term outcome of acute kidney injury due to leptospirosis? A longitudinal study in Sri Lanka. BMC Res Notes 2014; 7:398. [PMID: 24964804 PMCID: PMC4080986 DOI: 10.1186/1756-0500-7-398] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 06/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leptospirosis is an important zoonotic disease of variable severity and is a common cause of acute kidney injury (AKI) in tropics. However the knowledge on long term renal outcome in leptospirosis is scarce. This study aims to assess the long-term renal outcome of AKI caused by leptospirosis. FINDINGS Hospital records of patients who had developed AKI following leptospirosis (Serologically confirmed) presented to two Teaching Hospitals in Kandy district over 3 years from 2007 were studied. A total of 44 patients were included and they had been followed up at least for one year in out patient clinics with regular assessment including renal status. Renal histology was studied in two patients. The primary outcome measure was normalization of renal function at one year. Of the 44 patients, 31 were in the risk and injury stage (Group 1), and the rest of them were in the failure stage (Group 2) under RIFLE criteria. Of group 2 patients, 11 had abnormal renal functions on discharge. Their mean serum creatinine and GFR values on discharge were 392 mmol/l and 20 ml/min/1.73 m2. Other two patients had full renal recovery whilst in the hospital. Nine in the group 2 required renal replacement therapy by means of peritoneal dialysis, intermittent haemodialysis or haemofiltration. Seventeen out of the total had persistently abnormal renal functions on discharge. Of them 13 recovered their renal functions to normal. Four patients (9%) who belonged to group 2, had persistently abnormal renal functions after first year compatible with stage 3 chronic kidney disease (CKD). Renal histology of two patients showed tubulointerstitial lymphocyte infiltrate, tubular atrophy and interstitial fibrosis. CONCLUSION The long term renal outcome of AKI following leptospirosis is satisfactory as only 9% of patients had abnormal renal functions compatible with early stage of CKD. Even among them, advanced CKD or dialysis dependency had not been observed.
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Herath N, Wazil A, Kularatne S, Ratnatunga N, Weerakoon K, Badurdeen S, Rajakrishna P, Nanayakkara N, Dharmagunawardane D. Thrombotic microangiopathy and acute kidney injury in hump-nosed viper (Hypnale species) envenoming: a descriptive study in Sri Lanka. Toxicon 2012; 60:61-5. [PMID: 22483846 DOI: 10.1016/j.toxicon.2012.03.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/01/2012] [Accepted: 03/20/2012] [Indexed: 12/18/2022]
Abstract
Hump-nosed viper (Hypnale species) bites are common in Sri Lanka and a proportion of these bites lead to coagulation abnormalities and acute kidney injury (AKI). We observed thrombotic microangiopathy (TMA) among some of these patients, but its contribution to severity of AKI and other morbidities remains unknown. Thus, we report a case series of TMA following hump-nosed viper bite addressing the complications and renal out comes in Sri Lanka. This was a prospective observational study carried out at the nephrology unit, Kandy in Sri Lanka from October 2010 to October 2011 and included 11 patients with AKI following hump-nosed viper bites. All eleven cases needed renal replacement therapy (RRT) with intermittent haemodialysis for a period of 1-5 weeks. Of them, 7 patients developed TMA with evidence of microangiopathic haemolytic anaemia (MAHA), thrombocytopenia and severe anaemia needing multiple blood transfusions. They needed longer duration of RRT (range 2-5 weeks); 2 patients developed chronic kidney disease and two died during acute stage. Autopsy study found thrombosis of micro-vessels. Thrombotic microangiopathy could be a causative pathology of AKI in hump-nosed viper bite carrying poor outcome.
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Affiliation(s)
- Nalaka Herath
- Nephrology and Transplant Unit, Teaching Hospital, Kandy, Sri Lanka.
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Maduwage K, Kularatne K, Wazil A, Gawarammana I. Coagulopthy, acute kidney injury and death following Hypnale zara envenoming – The first case report from Sri Lanka. Toxicon 2011; 58:641-3. [DOI: 10.1016/j.toxicon.2011.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 09/13/2011] [Accepted: 09/22/2011] [Indexed: 10/17/2022]
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