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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Erandika N, Nanayakkara N, Wijetunge S, Rathnathunga N, Harishchandra PK, Fernando C, Weerasinghe C, Wazil AWM, Mahanama B, Basnayake D, Abeysundara H, Abeysekera RA. MO973PRE-IMPLANTATION BIOPSY FINDINGS AND IMPACT ON LIVE DONOR KIDNEY TRANSPLANT RECIPIENT OUTCOMES - A SINGLE CENTRE STUDY. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab110.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Live donor kidney transplantation remains the mainstay of renal replacement therapy in Sri Lanka. The basic universal pre surgical investigations, human leucocyte antigen (HLA) matching and cross matching are routinely performed, however due to high rates chronic kidney disease (CKD) as well as increasing numbers of, chronic kidney disease unknown etiology (CKDu) in Sri Lanka, there is a possibility of subclinical kidney disease being present in donor kidneys which go undiagnosed. A study of pre-implantation biopsy along with follow-up outcomes of kidney transplant recipients is conducted to identify presence of subclinical kidney disease in a Sri Lankan cohort of patients.
Method
We collected thirty three (33) live donor pre-implantation biopsies during 4 consecutive months in 2020 as well as 1 month follow-up data. This is part of an ongoing follow-up study which is conducted at National Hospital, Kandy, Sri Lanka.
Results
Thirty three (33) live donor recipients and their pre-implantation renal biopsy samples were studied. The mean age of the study participants’ was 37.6 (SD 12.5, range 13 - 59) years. A predominant number of male patients were in the sample (n=21, 63.6%). Underlying aetiology of end stage renal disease (ESRD), was predominantly due to chronic hypertension (39.3%; n=13) and diabetic kidney disease (21.2%, n=7) accounting for nearly 60% of the study participants. Among the 33 live donors 1st degree, 2nd degree and non-relative donors were 54.4% (n=18), 18.2% (n=6) and 27.3% (n=9) respectively. Pre-implantation renal biopsy results reported 36.4% (n=12) with abnormal biopsy findings including chronic interstitial nephritis (n=4, 12.1%), interstitial fibrosis (n=6, 18.18%) and acute tubular necrosis (n=2, 6%). Follow-up revealed delayed graft function occurring in 18.2% (n=6) of recipients with 50% (n=3) of them showing abnormalities in the pre-operative donor biopsy sample. At one month follow-up, 48.5% (n=16) reported complications which included graft failure 3% (n=1), all-cause mortality 3% (n=1), acute rejection 39.4% (n=13) and infections 24.2% (n=8). Overall, 37.5% (n=6) of these recipients had abnormal donor biopsy findings, however no significant statistical association was identified.
Conclusion
Our study identified subclinical kidney disease in donor kidneys despite standard pre-transplant screening. Even though, statistically not significant, recipients with abnormal pre-implantation biopsy findings had adverse short term post-transplant complications.
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Affiliation(s)
- Naduni Erandika
- University of Peradeniya, Faculty of Medicine, Kandy, Sri Lanka
| | | | | | | | - P K Harishchandra
- National Hospital, Kandy, Nehrology and Transplant Unit, Kandy, Sri Lanka
| | - Charitha Fernando
- National Hospital, Kandy, Nehrology and Transplant Unit, Kandy, Sri Lanka
| | | | - A W M Wazil
- National Hospital, Kandy, Nehrology and Transplant Unit, Kandy, Sri Lanka
| | - Buddhisha Mahanama
- National Hospital, Kandy, Nehrology and Transplant Unit, Kandy, Sri Lanka
| | - Duminda Basnayake
- National Hospital, Kandy, Nehrology and Transplant Unit, Kandy, Sri Lanka
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Premarathne S, Nanayakkara N, Chandrajith R, Rathnayake RMSK, Rathnathunga N, Badurdeen Z, Abeysundara H, Elladeniya N, Guruge K, Madushan S, Samrasiri U, Hewavitharane HPM. P0224THE POSSIBLE LINK BETWEEN UNDETERMINED CHRONIC KIDNEY DISEASE (CKDU) AND ACUTE INTERSTITIAL NEPHRITIS (AIN) IN THE DRY ZONE REGIONS OF SRI LANKA. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
An environmental nephropathy which is widely known as Chronic Kidney Disease of uncertain aetiology (CKDu) has been reported in dry zone of Sri Lanka and few other tropical countries. It is already become a major public health problem resulting immense social, economic and health impacts. In recent past, symptomatic presentation of CKDu with tubulitis (CKDuT)/ Acute Interstitial Nephritis indicating activity (AIN) has been reported from Sri Lanka and Central America. The AIN is a nonspecific response of kidney to an injurious agent. Usually the responsible aetiology is obvious in AIN, but not in CKDu cases, however, believed to be a sequel of interstitial nephritis. The aim of this study was to identify the occupational exposures or risk factors associated in AIN cases.
Method
In a two years of a comprehensive investigation, 60 individuals who reported with AIN were investigated. Once a case is reported, a home visit was carried out and behavioural pattern associated risk factors were assessed by a structured questionnaire in which working behaviours and conditions, spraying of agrochemical, usage of Personal Protective Equipment (PPE) and probable exposed environmental conditions were considered.
Results
Majority of AIN patients were male (90:10%) with the mean age of (44 ± 1.2) ranging from 26 - 62years. Among the study group, 53% were full time farmers while 77% of were doing farming either full time or part time. 55% of patients applied agrochemicals by themselves. 52% of individuals have used Personal Protective Equipment (PPE). 12% of individuals were sand miners while 7% and 5% were full time masons or labourers. 2% were engaged both farming and mason as full time employment. 15% were doing other employment except the above. Smoking, alcohol consumption and betel chewing were reported in the group as 50%, 57% and 72% respectively. Majority of patients were reported from Girandurukotte (17%), Wilgamuwa (32%) and Mahiyanganaya (35%) regions where CKDu are widely reported. Study indicated that there was no any significant pattern of AIN incidents over the study period.
Conclusion
Mean age of reported CKDuT were at least ten years younger than the mean age of CKDu. Comparatively higher number of sex ratio has been found in CKDuT indicating the male dominance. Some of the demographic features of AIN patients were similar with CKDu patients and both CKDu and AIN patients are engaged in farming either full time or part time.
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Affiliation(s)
- Shakila Premarathne
- Center for Education Research and Training on Kidney Diseases (CERTKID), Faculty of Medicine, University of Peradeniya, Department of Microbiology, Kandy, Sri Lanka
| | | | - Rohana Chandrajith
- Department Of Geology, Faculty of Science, University of Peradeniya, Sri Lanka, Department of Geology, Kandy, Sri Lanka
| | | | | | - Zeid Badurdeen
- Center for Education Research and Training on Kidney Diseases (CERTKID), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Hemalika Abeysundara
- Faculty of Science, University of Peradeniya, Department of Statistics ad Computer Sciences, Kandy, Sri Lanka
| | | | - Kumudumali Guruge
- Centre for Education, Research and Training on Kidney Diseases, Peradeniya, Sri Lanka
| | | | | | - H P M Hewavitharane
- Centre for Education, Research and Training on Kidney Diseases, Community Medicine, Kandy, Sri Lanka
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BADURDEEN Z, Hemage R, Fernando B, Hettiarachchi- T, Dharmasiri T, Ratnatunga N, Abeysekera T, Abeysundara H, Hettipolage S, Nishantha N. SAT-176 A PILOT STUDY: MANIFESTATION OF CANDIDATE RENAL BIOMARKERS IN PATIENTS WITH CHRONIC KIDNEY DISEASE OF UNCERTAIN ETIOLOGY. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.210] [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: 10/26/2022] Open
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Fernando WBNT, Hettiarachchi TW, Sudeshika T, Badurdeen Z, Abeysundara H, Ranasinghe S, Rathnayake MP, Nanayakkara N. Snap shot view on anaemia in chronic kidney disease of uncertain aetiology. Nephrology (Carlton) 2019; 24:1033-1040. [DOI: 10.1111/nep.13545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 12/13/2022]
Affiliation(s)
| | - Thilini W Hettiarachchi
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of MedicineUniversity of Peradeniya Sri Lanka
| | - Thilini Sudeshika
- Department of Pharmacy, Faculty of Allied Health SciencesUniversity of Peradeniya Sri Lanka
| | - Zeid Badurdeen
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of MedicineUniversity of Peradeniya Sri Lanka
| | - Hemalika Abeysundara
- Department of Statistics and Computer Science, Faculty of ScienceUniversity of Peradeniya Kandy Sri Lanka
| | - Shirani Ranasinghe
- Department of BiochemistryFaculty of Medicine, University of Peradeniya Kandy Sri Lanka
| | - Manel P Rathnayake
- Department of Pathology, Faculty of MedicineUniversity of Peradeniya Kandy Sri Lanka
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