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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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Hewavitharana P, Schensul S, Lee E, Montez-Rath M, Senarathne S, Liu S, Harold K, Hewapathiranage S, Erandika N, Abeysundara HT, Yu X, Bhalla V, Fire A, Levin A, Anand S, Vlahos P, Chandrajith R, Nanayakkara N. Describing Natural History and Exploring Risk Factors for Kidney Function Decline in Persons With CKD of Uncertain Etiology in Sri Lanka. Kidney Int Rep 2023; 8:1430-1438. [PMID: 37441476 PMCID: PMC10334401 DOI: 10.1016/j.ekir.2023.04.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Chronic kidney disease of uncertain etiology (CKDu) is a leading cause of death of adults in Sri Lanka's dry region. Methods We initiated the Kidney Progression Project (KiPP) to prospectively follow 292 persons with Chronic Kidney Disease Epidemiology Collaboration estimated glomerular filtration rate (eGFR) 20 to 60 ml/min per 1.73 m2 living in a CKDu endemic area. Using data from 3-year follow-up, we assessed kidney function decline (>30% from baseline eGFR), and the composite outcome of >30% eGFR decline, eGFR <15 ml/min or death, and explored the association of the 2 outcomes with baseline demographic, residential, and clinical parameters accounting for baseline eGFR. Results Median eGFR at enrollment was 28 ml/min among 71 women; 30 ml/min among 221 men; 91% to 99% had trace or no proteinuria during follow-up. At enrollment, median serum sodium, uric acid, and potassium were 143 mmol/l, 6.3 mg/dl, 4.5 meq/l, respectively among women; and 143 mmol/l, 6.9 mg/dl, 4.3 meq/l among men. Mean slope of eGFR decline was -0.5 (SD 4.9) ml/min/yr. In exploratory analyses, men with greater years of education and those living in northern region of the study area experienced lower likelihood of disease progression (hazard ratios [HR] 0.87 [0.77-0.98] per additional year and 0.33 [0.12-0.89] for northern versus other subregions, respectively). There was a suggestion that men drinking well water had higher likelihood and men living further away from reservoirs had lower likelihood of >30% decline in eGFR (HR 2.07 [0.95-4.49] for drinking well water versus not, and HR 0.58 [0.32-1.05] per kilometer distance, respectively). Conclusions The overall rate of kidney function decline was slow in this CKDu cohort, similar to other nonalbuminuric CKD, and event rates were similar among men and women. Further etiologic investigations could focus on specific residence locale and water use.
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Affiliation(s)
- Pasan Hewavitharana
- Center for Research, National Hospital Kandy, Sri Lanka
- Department of Nursing, Faculty of Health Sciences, The Open University of Sri Lanka, Kandy, Sri Lanka
| | - Stephen Schensul
- School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Edison Lee
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Maria Montez-Rath
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Sachintha Senarathne
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Sai Liu
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Kaitlin Harold
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | | | | | - Hemalika T.K. Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Xue Yu
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Vivek Bhalla
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Andrew Fire
- Department of Pathology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Shuchi Anand
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Penny Vlahos
- Department of Marine Sciences, University of Connecticut, Groton, Connecticut, USA
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Nishantha Nanayakkara
- Center for Research, National Hospital Kandy, Sri Lanka
- Nephrology and Kidney Transplant Unit, National Hospital Kandy, Sri Lanka
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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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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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Smyth B, Glaser J, Butler-Dawson J, Nanayakkara N, Wegman DH, Anand S, Levin A, Correa Rotter R, Eckardt KU, Fire A, Friedman D, Herath C, Jha V, Wijewickrama E, Yang CW, Bajpai D, Pippias M, Ulasi I, Nangaku M. Challenges and opportunities in interventions for chronic kidney disease of unknown origin (CKDu): report from the International Society of Nephrology Consortium of Collaborators on CKDu. Kidney Int 2023; 103:6-12. [PMID: 36603985 DOI: 10.1016/j.kint.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Brendan Smyth
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia; Department of Renal Medicine, St George Hospital, Kogarah, New South Wales, Australia
| | - Jason Glaser
- La Isla Network, Washington, District of Columbia, USA
| | - Jaime Butler-Dawson
- Center for Health, Work, and Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - David H Wegman
- La Isla Network, Washington, District of Columbia, USA; Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, California, USA.
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Edirithilake T, Nanayakkara N, Lin XX, Biggs PJ, Chandrajith R, Lokugalappatti S, Wickramasinghe S. Urinary MicroRNA Analysis Indicates an Epigenetic Regulation of Chronic Kidney Disease of Unknown Etiology in Sri Lanka. Microrna 2023; 12:156-163. [PMID: 36733246 DOI: 10.2174/2211536612666230202152932] [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: 05/02/2022] [Revised: 11/02/2022] [Accepted: 11/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic kidney disease of unknown etiology (CKDu) is reported among male paddy farmers in the dry zone of Sri Lanka. The exact cause of this disease remains undetermined. Genetic susceptibility is identified as a major risk factor for CKDu Objectives: In this study, small urinary RNAs were characterized in CKDu patients, healthy endemic and non-endemic controls. Differently expressed urinary miRNAs and their associated pathways were identified in the study population. METHODS Healthy and diseased male volunteers (n = 9) were recruited from Girandurukotte (endemic) and Mawanella (non-endemic) districts. Urinary small RNAs were purified and sequenced using Illumina MiSeqTM. The sequence trace files were assembled and analyzed. Differentially ex-pressed miRNAs among these three groups were identified and pathway analysis was conducted. RESULTS The urine samples contained 130,623 sequence reads identified as non-coding RNAs, PIWI-interacting RNAs (piRNA), and miRNAs. Approximately four percent of the total small RNA reads represented miRNA, and 29% represented piRNA. A total of 409 miRNA species were ex-pressed in urine. Interestingly, both diseased and endemic controls population showed significantly low expression of miRNA and piRNA. Regardless of the health status, the endemic population ex-pressed significantly low levels of miR-10a, miR-21, miR-148a, and miR-30a which have been linked with several environmental toxins Conclusion: Significant downregulation of miRNA and piRNA expression in both diseased and healthy endemic samples indicates an epigenetic regulation of CKDu involving genetic and environmental interaction. Further studies of specific miRNA species are required to develop a miRNA panel to identify individuals susceptible to CKDu.
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Affiliation(s)
- Thanuri Edirithilake
- Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | | | - Xiao Xiao Lin
- Massey Genome Service, School of Natural Sciences, Massey University, Palmerston North, 4442, New Zealand
| | - Patrick J Biggs
- Molecular Epidemiology & Public Health Laboratory (mEpiLab), Infectious Disease Research Centre, School of Veterinary Science, Massey University, Palmerston North, 4442, New Zealand
- School of Natural Sciences, Massey University, Palmerston North, 4442, New Zealand
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Sampath Lokugalappatti
- Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Saumya Wickramasinghe
- Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya 20400, Sri Lanka
- Department of Food Science and Technology, University of California, Davis, 95616, USA
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Abeywardana KDST, Rajamanthri RGLS, Wazil AWM, Nanayakkara N, Muthugala MARV. Longitudinal viral kinetic study of BK virus in renal transplant patients-A single-centre study in Sri Lanka. Journal of Clinical Virology Plus 2022. [DOI: 10.1016/j.jcvp.2022.100125] [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: 11/18/2022] Open
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10
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Premarathne S, Chandrajith R, Nanayakkara N, Gamage CD, Ratnatunga N, Wijetunge S, Badurdeen Z, Guruge S, Elladeniya N, Madushan KPS, Samarasiri KOCU, Hewavitharane P, Herath D, Senarathne S. Could Consumption of Trace Element-Contaminated Rice Be a Risk Factor for Acute Interstitial Nephritis with Uncertain Etiology in the Dry Zone of Sri Lanka? Biol Trace Elem Res 2022; 200:2597-2605. [PMID: 34431070 DOI: 10.1007/s12011-021-02880-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Ingestion of toxic trace elements in the human body has been considered one of the major reasons for renal dysfunction. Chronic kidney disease with uncertain etiological factors (CKDu) is a recently described clinical entity in which the disease is found in geographically isolated pockets in the dry zone of Sri Lanka. In CKDu regions, an increasing number of cases are reported with acute interstitial nephritis without any known reason (AINu). However, recent exposure to certain risk behaviors or nephrotoxins, or both, is suspected for the AINu. Consumption of foods that are contaminated with trace elements is one of the main pathways of human exposure to environmental toxins. The current study was carried out to assess the possibility of trace element-contaminated rice consumption on the etiopathogenesis of AINu. Samples of rice consumed by 32 clinically diagnosed AINu cases were collected and analyzed for possible nephrotoxic trace elements. Out of 32 patients, 26 were histologically confirmed with tubulointerstitial disease. The results revealed that the mean values of Cd, As, and Pb were 0.18, 0.055, and 0.135 mg/kg, with ranges of 0.020-1.06, 0.012-0.222, and 0.003-0.744 mg/kg (on dry weight basis), respectively. This study indicated that the investigated toxic trace element levels of rice consumed by AINu were reasonably below the recommended levels of the Codex Alimentarius Commission of FAO and WHO. Hence, it is less likely that rice consumption is to be a risk factor for the etiology of AINu.
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Affiliation(s)
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka.
| | | | - C D Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Sulochana Wijetunge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Zeid Badurdeen
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Shashika Guruge
- State Key Laboratory of Environmental Aquatic Chemistry, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, 100085, China
| | - N Elladeniya
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - K P S Madushan
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - K O C U Samarasiri
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | | | | | - Sachintha Senarathne
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
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Gunarathne TGNS, Tang LY, Lim SK, Nanayakkara N, Damayanthi HDWT, Abdullah KL. Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study. Int J Environ Res Public Health 2022; 19:ijerph19095540. [PMID: 35564935 PMCID: PMC9105408 DOI: 10.3390/ijerph19095540] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023]
Abstract
People with end stage renal disease and undergoing hemodialysis experience a high symptom burden that impairs quality of life. This study aimed to assess the prevalence, dynamicity and determinants of symptom burden among middle-aged and older adult hemodialysis patients. A descriptive cross-sectional study together with a longitudinal assessment was used. A total of 118 and 102 hemodialysis patients were assessed at baseline and at a 6-month follow-up. Validated questionnaires were used to assess the symptom burden, stress, illness perception and social support. Multiple linear regression analysis was used to determine the factors associated with symptom burden. The median number of symptoms experienced was 21 (Interquartile Range (IQR); 18−23) and 19 (IQR; 13−22) at baseline and 6 months, respectively. Having elevated stress (β = 0.65, p ≤ 0.005) and illness perception (β = 0.21, p = 0.02) were significantly predicted symptom burden at baseline (F (4, 112) = 55.29, p < 0.005, R2 = 0.664). Stress (β = 0.28, p = 0.003), illness perception (β = 0.2, p = 0.03), poor social support (β = −0.22, p = 0.01) and low body weight (β = −0.19, p = 0.03) were the determinants for symptom burden at 6 months (F (5, 93) = 4.85, p ≤ 0.005, R2 = 0.24). Elevated stress, illness perception level, poor social support and low post-dialysis body weight were found to be determinants for symptom burden. Attention should be given to psychosocial factors of hemodialysis patients while conducting assessment and delivering care to patients.
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Affiliation(s)
- Thalwaththe Gedara Nadeeka Shayamalie Gunarathne
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; or
- Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya 20400, Sri Lanka;
| | - Li Yoong Tang
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; or
- Correspondence: ; Tel.: +603-7949-3646
| | - Soo Kun Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | | | | | - Khatijah L. Abdullah
- Department of Nursing, School of Medical and Life Science, Sunway University, Bandar Sunway 47500, Malaysia;
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12
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Hewapathiranage S, Nayanamali A, Nanayakkara N. MO388: A Critical Evaluation of Anthropological, Biological and Geo-Environmental Factors on Chronic Kidney Disease of unknown Aetiology in Affected Area Against Unaffected Area. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac070.002] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Chronic kidney disease of unknown etiology (CKDu) has been a critical health issue among the farming communities of Sri Lanka for decades [1]. However, the distribution of CKDu in Sri Lanka is geographically significant by representing endemicity on its own [2]. This study was conducted to identify the anthropological and geo-environmental characteristics of CKDu, in relation to the biochemical profile between known CKDu endemic and non-endemic communities.
METHOD
A total of 214 male individuals from Wilgamuwa (endemic) and 102 male individuals from Mathurata (non-endemic) of 30–60 years were recruited. For each participant, blood pressure (BP), random blood sugar (RBS), serum creatinine (μmol/L) and serum cholesterol (mg/dL) were tested using standard methods. Anthropological data including population structure, farming behaviour and poverty statistics were obtained from the respective government officials. Geo climatic data including elevation, monthly average (Avg.) temperature (°C), monthly Avg. rainfall (mm), monthly Avg. humidity (%) and monthly Avg. UV intensity, monthly Avg. Sun hours (hrs.) were obtained for the two study areas.
RESULTS
Most striking difference between two communities is significantly high serum creatinine (t = 3.5175, P = 0.0005) in male individuals between the age category of 40 to 65 years in CKDu endemic area (M = 109.00, SD = 66.41) in comparison to non-endemic participants in the same age category from non-endemic area for CKDu (M = 85.41, SD = 18.78). The non-endemic area for CKDu, Maturata was colonized since the 16th century due to natural population migrations while the colonization of Wilgamuwa was implemented in a more drastic manner, parallel to the green revolution after the 1960s. Mathurata is located at a high elevation level of 976 m, whereas Wilgamuwa is located at an elevation level of 528 m. In comparison with meteorological variables for the year of 2019, monthly Avg. rainfall (mm) (P = 0.005), monthly Avg. temperature (°C) (P = 0.001), monthly Avg. cloud cover (%) (P = 0.004), monthly Avg. Humidity (%) (P = 0.007), monthly Avg. Sun hours (hrs) (P = 0.001) were highly significant between the two geographical areas.
CONCLUSION
We report comparably adverse weather conditions, higher exposure to natural and artificial toxic exposure in genetically and behaviourally vulnerable group in the CKDu endemic area in comparison with non-endemic area for CKDu.
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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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14
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BADURDEEN Z, Ratnatunga N, Abeysekera T, Nanayakkara N. POS-004 A CASE REPORT ON EPISODIC ACUTE INTERSTITIAL NEPHRITIS OF UNKNOWN ETIOLOGY. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.012] [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: 11/28/2022] Open
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15
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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. Environ Dis 2022. [DOI: 10.4103/ed.ed_3_22] [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: 11/04/2022] Open
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16
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Nayanamali MAA, Athapaththu AMMP, Basnayake BMDB, Gunarathne TGNS, Wazil AM, Mahanama RMBSS, Thangarajah BEWDR, Nanayakkara N. Epidemiology, risk factors, and major outcomes in post kidney transplant infections at national hospital kandy: A cross-sectional, pilot study. Indian J Transplant 2022. [DOI: 10.4103/ijot.ijot_132_20] [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: 11/04/2022] Open
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17
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Amarathunga H, Pathiraja J, Basnayaka D, Kariyawasam A, Wazil M, Nanayakkara N, Sivapalan M, Ranaweera L, Uyanege L, Jayatissa R. Muscle strength in chronic maintenance haemodialysis patients. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.360] [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: 11/25/2022]
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18
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Erandika N, Basnayake D, Hewapathiranage S, Weerakoon C, Hasantha I, Herath D, Nanayakkara N. Hypocalcemia, hypophosphatemia and non-specific arthralgia in chronic kidney disease unknown origin in Sri Lanka. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.398] [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: 11/28/2022]
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19
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Abeywickrama H, Koyama Y, Wimalasiri S, Uchiyama M, Shimizu U, Chandrajith R, Nanayakkara N. Anthropometric changes in chronic kidney disease of unknown etiology (CKDU) patients: a single-center longitudinal study in Sri Lanka. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.421] [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: 11/26/2022]
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20
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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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21
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Godawita R, Nayanamali A, Silva R, Nanayakkara N. MO534 VITAMIN D DEFICIENCY IN PATIENTS WITH CHRONIC KIDNEY DISEASE OF UNCERTAIN ETIOLOGY IN WILGAMUWA, SRI LANKA. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab087.0054] [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
Vitamin D deficiency (VDD) is a common, well known association in Chronic Kidney Disease (CKD). However, there are no published studies on the prevalence of VDD among CKDu (Chronic Kidney Disease of uncertain etiology) patients. This study aims to study on Vitamin D status of CKDu patients.
Method
This was a cross sectional survey conducted in Wilgamuwa area, in Mathale located in Central province of Sri Lanka. Among the 39 GN (Grama Niladahri) divisions at Wilgamuwa, GN divisions where the CKD prevalence was high areas were taken for the study. Data were collected by using clinical examination and interviewer administered questionnaire and analyzed using SPSS statistical software
Results
A total of 150 patients living in a CKDu endemic area in Sri Lanka was studied during the study period. Majority (n=118, 78.7%) of the CKDu patients were males. Mean age (years) was 56.75±7.89 and 54.34±7.87 for females and males respectively. More than half of the patients were middle aged outdoor workers. According to the BMI (Body mass index) results, majority (n= 87, 58%) of the CKDu patients were in the healthy weight category. More than one third of the patients were in the underweight category. VDD (<20ng/mL) was reported in 22.88% (n=27) of the total males and 68.75% (n=22) of the total females. Vitamin D insufficiency (20-30ng/mL) was identified among 45.76% (n=54) males and 25% (n=8) females. Rest of the males (31.35, n=37) and females (6.25%, n=2) had normal vitamin D level (>30 ng/mL). As a summary the mean Vitamin D level was 24.85 ±7.93 ng/mL. There was a significant different in the prevalence of VDD between gender groups (p = 0.004). VDD is more common (82%) during the early stages of CKDu while less common during the late stage. However, there is no any significant association between the prevalence of VDD and CKDu stage (p=0.183).
Conclusion
VDD is more commonly encountered complication in during the early stages of CKDu and it was significantly high in male CKDu patients compared to females.
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Affiliation(s)
- Rivindi Godawita
- University of Peradeniya, Postgraduate Institute of Agriculture, Kandy, Sri Lanka
| | | | - Renuka Silva
- Wayamba University of Sri Lanka Makandura Premises, Department of Applied Nutrition, Sri Lanka
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22
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Hettiarachchi TW, Fernando BNTW, Sudeshika T, Badurdeen Z, Anand S, Kularatne A, Wijetunge S, Abeysundara HTK, Nanayakkara N. Prevalence, risk factors and predicted risk of cardiac events in chronic kidney disease of uncertain aetiology in Sri Lanka: A tubular interstitial nephropathy. PLoS One 2021; 16:e0249539. [PMID: 33852602 PMCID: PMC8046203 DOI: 10.1371/journal.pone.0249539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/21/2021] [Indexed: 11/19/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with ‘traditional’ chronic kidney disease (CKD). However, chronic kidney disease of uncertain aetiology (CKDu), a tubular interstitial nephropathy is typically minimally proteinuric without high rates of associated hypertension or vascular disease and it is unknown if the rates of CVD are similar. This study aimed to identify the prevalence and the risk of CVD in patients with CKDu. This cross-sectional study included patients with confirmed CKDu who were attending two renal clinics in CKDu endemic-area. A detailed medical history, blood pressure, electrocardiogram (resting and six minutes vigorous walking), echocardiograms, appropriate laboratory parameters and medical record reviews were used to collect data at baseline. The WHO/Pan American Health Organization, cardiovascular risk calculator was employed to determine the future risk of CVD. The clinics had recorded 132 number of patients with CKDu, of these 119 consented to participation in the study. The mean age was 52 (± 9.5) years and mean eGFR was 51.1 (± 27.61); a majority (81.5% (n = 97)) were males. Thirty-four patients (28.6%) had evidence of ischaemic heart disease (IHD). Troponin-I (p = 0.02), Age >50 years (p = 0.01) and hyperuricemia (p = 0.01) were significantly associated with IHD in CKDu. Left ventricular hypertrophy was reported in 20.2% (n = 24). According to the risk calculator, 97% of the enrolled patients were at low risk (<10%) for experiencing a cardiovascular event within the next 10 years. Patients with CKDu have low prevalence and risk for CVD, implying that a majority are likely to survive to reach end-stage kidney disease. Our findings highlight the need for developing strategies to minimize the progression of CKDu to end-stage renal disease.
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Affiliation(s)
- Thilini W. Hettiarachchi
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Galaha, Sri Lanka
- * E-mail:
| | - Buddhi N. T. W. Fernando
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
| | - Thilini Sudeshika
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Galaha, Sri Lanka
| | - Zeid Badurdeen
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Galaha, Sri Lanka
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, United States of America
| | | | - Sulochana Wijetunge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Galaha, Sri Lanka
| | - Hemalika T. K. Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Galaha, Sri Lanka
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23
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PATHIRAJA C, Lansakara M, Nanayakkara N, Wijesinghe S. POS-043 INCIDENCE OF ACUTE KIDNEY INJURY AFTER 0FF-PUMP CORONARY ARTERY BYPASS GRAFTING: SINGLE SURGEON, SINGLE CENTRE EXPERIENCE IN SRI LANKA. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.049] [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: 11/27/2022] Open
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24
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Hettiarachchi T, Sudeshika T, T. Fernando B, Abeysundara H, Hemage R, Badurdeen Z, Hanarasinghe R, Wijetunge S, Nanayakkara N. An Analysis of Rate of Progression and Associated Risk Factors of Chronic Kidney Disease of Uncertain Etiology in Sri Lanka. Saudi J Kidney Dis Transpl 2021; 32:711-721. [DOI: 10.4103/1319-2442.336766] [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: 11/04/2022] Open
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25
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Abeywickrama H, Koyama Y, Wimalasiri S, Uchiyama M, Shimizu U, Chandrajith R, Nanayakkara N. Association between chronic kidney disease of unknown etiology (CKDU) and anthropometric measures and indices: A case-control study in Sri Lanka. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.206] [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: 10/23/2022]
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26
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Amarathunga H, Pathiraja J, Basnayaka D, Kariyawasam A, Gunasinghe C, Nanayakkara N, Wazil M, Menike J. Electrolyte disorders in patients undergoing chronic hemodialysis. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.697] [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: 10/23/2022]
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27
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Nanayakkara S, Senevirathna STMLD, Harada KH, Chandrajith R, Nanayakkara N, Koizumi A. The Influence of fluoride on chronic kidney disease of uncertain aetiology (CKDu) in Sri Lanka. Chemosphere 2020; 257:127186. [PMID: 32516669 DOI: 10.1016/j.chemosphere.2020.127186] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 06/11/2023]
Abstract
Fluoride is an element that is widely distributed in the environment. The involvement of fluoride in pathogenesis of Chronic Kidney Disease of uncertain aetiology (CKDu) in Sri Lanka is a much-debated topic. This study aimed to investigate the fluoride concentration in drinking water in CKDu affected areas in Sri Lanka and to evaluate the possible effect of renal impairment on serum fluoride levels in CKDu patients. Drinking water (n = 60) from the common water sources from two CKDu prevalent areas and serum samples of CKDu patients (n = 311) and healthy controls (n = 276) were collected. Both environmental and biological samples were analysed for the concentration of fluoride. The fluoride concentration in over 95% of drinking water samples was below the WHO guideline of 1.5 mg/L. Serum fluoride concentrations in majority of the unaffected and early-stage CKDu patients (stages 1 and 2, eGFR >60 ml/min/1.73m2) were below the normal upper concentration of 50 μg/l and significantly higher levels were observed in patients in late stages of CKDu compared to the healthy controls. The available guidelines for drinking water are solely based on healthy populations with normal renal function. But, it is evident that once the kidney function is impaired, patients enter a vicious cycle as fluoride gradually accumulates in the body, further damaging the kidney tissue. Thus, close monitoring of serum fluoride levels in CKDu patients and establishing health-based target guidelines for fluoride in drinking water for the CKDu patients are recommended to impede the progression to end stage renal disease.
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Affiliation(s)
- Shanika Nanayakkara
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute of Dental Research, Westmead Centre for Oral Health, Westmead Hospital, Westmead, Australia.
| | - S T M L D Senevirathna
- Faculty of Business, Justice and Behavioural Sciences, School of Engineering, Charles Sturt University, Bathurst, Australia
| | - Kouji H Harada
- Department of Health and Environmental Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Sri Lanka
| | - Nishantha Nanayakkara
- Kandy Teaching Hospital and Center for Research and Training on Kidney Diseases, University of Peradeniya, Kandy, Sri Lanka
| | - Akio Koizumi
- Institute of Public Health and Welfare Research, Nakagyoku, Kyoto, Japan
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Fernando BNTW, Sudeshika T, Hettiarachchi TW, Badurdeen Z, Abeysekara TDJ, Abeysundara HTK, Jayasinghe S, Ranasighe S, Nanayakkara N. Correction: Evaluation of biochemical profile of Chronic Kidney Disease of uncertain etiology in Sri Lanka. PLoS One 2020; 15:e0238279. [PMID: 32817721 PMCID: PMC7444529 DOI: 10.1371/journal.pone.0238279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Abeywickrama HM, Wimalasiri S, Koyama Y, Uchiyama M, Shimizu U, Kakihara N, Chandrajith R, Nanayakkara N. Quality of Life and Symptom Burden among Chronic Kidney Disease of Uncertain Etiology (CKDu) Patients in Girandurukotte, Sri Lanka. Int J Environ Res Public Health 2020; 17:E4041. [PMID: 32517110 PMCID: PMC7312904 DOI: 10.3390/ijerph17114041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022]
Abstract
Symptom burden and health-related quality of life (HRQOL) are important predictors of how a disease affects patients' lives, especially for endemic health problems such as chronic kidney disease of uncertain etiology (CKDu). Our study describes symptom burden, HRQOL, and associated demographic and clinical variables in CKDu patients in the Girandurukotte area, Sri Lanka. A cross-sectional study included 120 CKDu patients attending the renal clinic in the endemic area. The instruments applied were the Kidney Disease Quality of Life-Short Form (KDQOL-SFTM) version 1.3 and CKD Symptom Index-Sri Lanka. Socio-demographic, disease-related, and anthropometric variables were also investigated. The mean age of patients was 61.87 (SD 11.31), while 69.2% were male. The mean glomerular filtration rate was 28.17 (SD 14.03) mL/min/1.73 min2, and 70.8% were anemic. Bone/joint pain was the most experienced symptom while the median number of symptoms reported by patients was 5 (IQR 3-7). The mean symptom burden, physical component summary, mental component summary, and kidney-disease-specific component scores were 12.71 (SD 10.45), 68.63 (SD 19.58), 78.53 (SD 18.78), and 81.57 (SD 5.86), respectively. Age was found to be a significant predictor of HRQOL, while hemoglobin level and being a farmer were significant predictors of symptom burden. Our data indicate that CKDu patients in all stages experience at least one symptom affecting all aspects of HRQOL.
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Affiliation(s)
- Hansani Madushika Abeywickrama
- Graduate School of Health Sciences, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746, Asahimachi, Niigata 951-8518, Japan; (M.U.); (U.S.); (N.K.)
| | - Swarna Wimalasiri
- Department of Food Science and Technology, Faculty of Agriculture, University of Peradeniya, Kandy 20400, Sri Lanka;
| | - Yu Koyama
- Graduate School of Health Sciences, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746, Asahimachi, Niigata 951-8518, Japan; (M.U.); (U.S.); (N.K.)
| | - Mieko Uchiyama
- Graduate School of Health Sciences, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746, Asahimachi, Niigata 951-8518, Japan; (M.U.); (U.S.); (N.K.)
| | - Utako Shimizu
- Graduate School of Health Sciences, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746, Asahimachi, Niigata 951-8518, Japan; (M.U.); (U.S.); (N.K.)
| | - Nahoko Kakihara
- Graduate School of Health Sciences, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746, Asahimachi, Niigata 951-8518, Japan; (M.U.); (U.S.); (N.K.)
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy 20400, 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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fernando WBNT, Nanayakkara N, Gunarathne L, Chandrajith R. Serum and urine fluoride levels in populations of high environmental fluoride exposure with endemic CKDu: a case-control study from Sri Lanka. Environ Geochem Health 2020; 42:1497-1504. [PMID: 31641912 DOI: 10.1007/s10653-019-00444-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/09/2019] [Indexed: 05/24/2023]
Abstract
Chronic kidney disease of uncertain etiology (CKDu) is a common health issue among farming communities in the dry zone of Sri Lanka where groundwater fluoride is known to be higher than recommended levels. Excessive environmental ingestion of fluoride is widely considered as a possible factor for the onset of CKDu. This study was carried out to evaluate the serum and urine fluoride levels in biopsy-proven, non-dialysis CKDu patients. Control subjects were selected from the same area without any deteriorated kidney functions. Serum and urine fluoride levels were determined by ion-selective electrode method. Higher content of serum and urine fluoride levels were observed in patients with chronic renal failures. In CKDu cases, the serum fluoride concentrations ranged between 0.47 and 9.58 mg/L (mean 1.39 ± 1.1 mg/L), while urine levels were varied between 0.45 and 6.92 mg/L (mean 1.53 ± 0.8 mg/L). In patients, urine fluoride levels showed a significant difference with the CKDu stage; however, no difference was obtained between genders and age. In endemic controls, serum and urine fluoride levels ranged between 0.51 and 1.92 mg/L (mean = 1.07 ± 0.3 mg/L) and 0.36 and 3.80 mg/L (mean = 1.26 ± 0.6 mg/L), respectively. Significantly higher fluoride in serum and urine was noted in CKDu patients compared to endemic control groups. Higher fluoride exposure via drinking water is possibly the reason for higher fluoride in serum, while excessive urinary excretion would be due to deterioration of the kidney, suggesting a possible nephrotoxic role of environmental fluoride exposure.
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Affiliation(s)
- W B N T Fernando
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka.
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Basnayake BMDB, Wazil AWM, Nanayakkara N, Samarakoon SMDK, Senavirathne EMSK, Thangarajah BUEWDR, Karunasena N, Mahanama RMBSS. Atypical hemolytic uremic syndrome: a case report. J Med Case Rep 2020; 14:11. [PMID: 31928535 PMCID: PMC6956473 DOI: 10.1186/s13256-019-2334-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/26/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Thrombotic microangiopathy is a pathological condition comprised of microvascular thrombosis involving any organ of the body leading to thrombocytopenia, Coombs-negative hemolytic anemia, and end-organ damage. The most common forms of thrombotic microangiopathies are Shiga toxin-producing Escherichia coli-mediated hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and atypical hemolytic uremic syndrome. The atypical hemolytic uremic syndrome occurs due to genetic and acquired mutations in complement regulatory factors and to complement activation factors in the immune system, mainly the alternative pathway. Clinical manifestations and outcomes differ with the prevalent mutations of the patient. Currently, available treatment modalities are therapeutic plasma exchange and a monoclonal antibody against C5, eculizumab. We report a case of a Sri Lankan girl diagnosed with atypical hemolytic uremic syndrome complicated with septicemia, hemolytic anemia, acute kidney injury, pulmonary hemorrhage with respiratory failure, and hypertension who had a complete remission following long-term (30 months) therapeutic plasma exchange. CASE PRESENTATION A 15-year-old Sri Lankan girl was transferred from a local hospital with the features of septicemia and acute kidney injury for specialized management. She had high blood pressure (180/100 mmHg) on admission. She underwent appendicectomy based on suspicion of acute appendicitis as the cause of sepsis. Following surgery, her condition deteriorated, and intensive care unit management was warranted because she developed pulmonary hemorrhages and respiratory failure requiring mechanical ventilation and renal replacement therapy in the form of hemodialysis. Her blood investigations showed microangiopathic hemolytic anemia, thrombocytopenia, elevated lactate dehydrogenase, and reduced human complement C3 levels, together with a normal coagulation profile. She was diagnosed with atypical hemolytic uremic syndrome and was initiated on therapeutic plasma exchange and other supportive therapy, including corticosteroids. Following a lengthy course of plasma exchange, complete recovery was achieved. CONCLUSION The atypical hemolytic uremic syndrome is a rare disease entity requiring a high index of suspicion to diagnose. It is a diagnosis of exclusion. Early diagnosis with prompt treatment will render a better outcome. The atypical hemolytic uremic syndrome needs to be considered in all patients with thrombotic microangiopathy.
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Affiliation(s)
- B M D B Basnayake
- Department of Nephrology and Renal Transplant, Teaching Hospital Kandy, Kandy, Sri Lanka.
| | - A W M Wazil
- Department of Nephrology and Renal Transplant, Teaching Hospital Kandy, Kandy, Sri Lanka
| | - N Nanayakkara
- Department of Nephrology and Renal Transplant, Teaching Hospital Kandy, Kandy, Sri Lanka
| | - S M D K Samarakoon
- Department of Transfusion Medicine, Teaching Hospital Kandy, Kandy, Sri Lanka
| | | | | | - N Karunasena
- Department of Nephrology and Renal Transplant, Teaching Hospital Kandy, Kandy, Sri Lanka
| | - R M B S S Mahanama
- Department of Nephrology and Renal Transplant, Teaching Hospital Kandy, Kandy, Sri Lanka
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Anand S, Caplin B, Gonzalez-Quiroz M, Schensul SL, Bhalla V, Parada X, Nanayakkara N, Fire A, Levin A, Friedman DJ, Aguilar-Gonzalez A, Abbot K, Abeysekara T, Amann K, Anand S, Ashuntantang G, Bhalla V, Brooks D, Caplin B, Chavarria D, Christoph D, Rotter RC, De Broe M, De Silva PMC, Dominguez J, Eckardt KU, Fader D, Finkelstein F, Fire A, Fischer R, Friedman D, Ganguli A, Garcia Trabinho RA, Glaser J, Gonzalez Quiroz MA, Fischer R, Haider L(L, Harris D, Herath C, Herrera R, Hradsky A, Hoy W, Jakobsson K, Jayasinghe S, Jaysummana C, Jha V, Johnson R, Kambham N, Karanasema N, Kaze F, Kimmel P, Koritzinsky E, Langham R, Le Bellego L, Levin A, Levin N, Lyuckx V, Madero M, Martin E, Malik C, Moist L, Moxey-Mims M, Nanayakkara N, Narva A, Nerbass F, O'Donoghue D, Orantes C, Parada X, Pearce N, Ratnayake C, Roy-Chaudhury P, Ruggiero A, Sanchez-Lozada LG, Saran R, Schensul S, Segantini L, Seksek I, Sheikh-Hamad D, Star R, Strani L, Vlahos P, Wegman DH, Weiss I, Wijewickrama E, Wijkstrom J, Wise P, Wright E, Yang CW, Yeates K. Epidemiology, molecular, and genetic methodologies to evaluate causes of CKDu around the world: report of the Working Group from the ISN International Consortium of Collaborators on CKDu. Kidney Int 2019; 96:1254-1260. [DOI: 10.1016/j.kint.2019.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 11/30/2022]
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Sarathkumara YD, Gamage CD, Lokupathirage S, Muthusinghe DS, Nanayakkara N, Gunarathne L, Shimizu K, Tsuda Y, Arikawa J, Yoshimatsu K. Exposure to Hantavirus is a Risk Factor Associated with Kidney Diseases in Sri Lanka: A Cross Sectional Study. Viruses 2019; 11:v11080700. [PMID: 31370348 PMCID: PMC6723923 DOI: 10.3390/v11080700] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/16/2019] [Accepted: 07/30/2019] [Indexed: 01/25/2023] Open
Abstract
Chronic kidney disease of unknown etiology (CKDu) imposes a substantial burden on public health in Sri Lankan agricultural communities. High seroprevalences of hantavirus have been reported in CKDu patients in several locations of Sri Lanka. We carried out a cross-sectional study followed by an unmatched case-control comparison in two geographically distinct areas of Sri Lanka, Girandurukotte (CKDu endemic) and Kandy (CKDu non-endemic) to determine whether exposure to hantaviruses is a potential risk factor in patients with kidney disease. An indirect immunofluorescent antibody assay using two antigens, Thailand orthohantavirus-infected and recombinant N protein-expressing Vero E6 cells, were used for serodiagnosis. Participants' demographic and other socio-economic data were collected through a structured questionnaire. Fifty kidney disease patients and 270 controls from Kandy and 104 kidney disease patients and 242 controls from Girandurukotte were examined. Seropositivities were 50% and 17.4% in kidney patients and controls, respectively, in Girandurukotte, and they were 18% and 7% in Kandy. The odds of exposure to hantaviruses were higher for kidney disease patients than for controls in both Girandurukotte (OR:3.66, 95% CI:2.01 to 6.64) and Kandy (OR:2.64, 95% CI:1.07 to 6.54) in binary logistic regression models. According to statistical analysis, individuals exposed to hantaviruses had a higher risk of developing renal impairment. Therefore, hantavirus infection might be an important risk factor for development of kidney disease in Sri Lanka.
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Affiliation(s)
- Yomani D Sarathkumara
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Chandika D Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Sithumini Lokupathirage
- Department of Microbiology and Immunology, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Devinda S Muthusinghe
- Graduate School of Infectious Diseases, Hokkaido University, Sapporo 060-8638, Japan
| | - Nishantha Nanayakkara
- Nephrology and Transplantation Unit, Teaching Hospital Kandy, Kandy 20000, Sri Lanka
| | | | - Kenta Shimizu
- Department of Microbiology and Immunology, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Yoshimi Tsuda
- 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
| | - Kumiko Yoshimatsu
- Department of Microbiology and Immunology, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan.
- Graduate School of Infectious Diseases, Hokkaido University, Sapporo 060-8638, Japan.
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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 BMDB, Wazil AWM, Nanayakkara N, Mahanama RMBSS, Premathilake PNS, Galkaduwa KKMCDK. Ethylene glycol intoxication following brake fluid ingestion complicated with unilateral facial nerve palsy: a case report. J Med Case Rep 2019; 13:203. [PMID: 31266532 PMCID: PMC6607589 DOI: 10.1186/s13256-019-2139-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/14/2019] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Brake oil is an automobile transmission fluid composed of a mixture of toxic alcohols such as ethylene glycols and glycol ethers. Both accidental and intentional ingestion cases have been reported and they can present with multisystem involvement. Life-threatening complications evolve from deleterious effects on cardiopulmonary and renal systems. Effects on neurological and gastrointestinal systems give rise to a multitude of complications although non-fatal in nature. The biochemical panel consists of a high concentration of ethylene glycol with severe metabolic acidosis, high anion gap, high osmolar gap, oxaluria, and hypocalcemia. The mainstay of treatment is enhanced elimination of ethylene glycol and its metabolites by hemodialysis, together with general supportive care, gastric decontamination, and vitamins such as thiamine and pyridoxine to minimize the adverse effects of intoxication. Case presentation A 26-year-old Sinhalese woman presented with reduced urine output, shortness of breath, reduced level of consciousness, abdominal pain, and vomiting with mild degree fever of 2 days’ duration. She had bilateral lower limb edema, crepitations over bilateral lower lung fields, and right-sided lower motor type facial nerve palsy. Investigations showed severe metabolic acidosis with high anion gap and high osmolar gap. With regular hemodialysis she made a complete recovery after 3 months. Conclusion Even without a clear history of poisoning, the presence of a high anion, high osmolar gap metabolic acidosis should prompt one to search for ethylene glycol ingestion. Uncommon manifestations like cranial neuropathies need to be examined and considered. Timely aggressive treatment leads to a better prognosis.
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Affiliation(s)
- B M D B Basnayake
- Department of Nephrology and Renal Transplant, Teaching Hospital Kandy, Kandy, Sri Lanka.
| | - A W M Wazil
- Department of Nephrology and Renal Transplant, Teaching Hospital Kandy, Kandy, Sri Lanka
| | - N Nanayakkara
- Department of Nephrology and Renal Transplant, Teaching Hospital Kandy, Kandy, Sri Lanka
| | - R M B S S Mahanama
- Department of Nephrology and Renal Transplant, Teaching Hospital Kandy, Kandy, Sri Lanka
| | | | - K K M C D K Galkaduwa
- Department of Nephrology and Renal Transplant, Teaching Hospital Kandy, Kandy, 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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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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Anand S, Montez-Rath ME, Adasooriya D, Ratnatunga N, Kambham N, Wazil A, Wijetunge S, Badurdeen Z, Ratnayake C, Karunasena N, Schensul SL, Valhos P, Haider L, Bhalla V, Levin A, Wise PH, Chertow GM, Barry M, Fire AZ, Nanayakkara N. Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka. Clin J Am Soc Nephrol 2019; 14:224-232. [PMID: 30659059 PMCID: PMC6390926 DOI: 10.2215/cjn.07430618] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES A kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy. RESULTS From 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics-age, urine dipstick for protein, and serum albumin-could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease. CONCLUSIONS A primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.
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Affiliation(s)
| | | | - Dinuka Adasooriya
- Kandy Teaching Hospital, Kandy, Sri Lanka
- Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
| | | | | | | | | | - Zeid Badurdeen
- Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
| | | | | | | | - Penny Valhos
- Department of Marine Sciences, University of Connecticut, Groton, Connecticut; and
| | - Lalarukh Haider
- Division of Nephrology, University of Connecticut Health Center, Farmington, Connecticut
| | | | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Michele Barry
- Medicine, Stanford University School of Medicine, Palo Alto, California
| | | | - Nishantha Nanayakkara
- Kandy Teaching Hospital, Kandy, Sri Lanka
- Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
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Vlahos P, Schensul SL, Nanayakkara N, Chandrajith R, Haider L, Anand S, Silva KT, Schensul JJ. Kidney progression project (KiPP): Protocol for a longitudinal cohort study of progression in chronic kidney disease of unknown etiology in Sri Lanka. Glob Public Health 2018; 14:214-226. [PMID: 30095037 DOI: 10.1080/17441692.2018.1508480] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Over the last two decades, a global epidemic of chronic kidney disease of unknown etiology (CKDu) has emerged in rural, arid, agricultural, lowland areas. Endemic regions have reported 15 to 20% prevalence among residents aged 30-60 years. CKDu is a progressive and irreversible disease resulting in renal failure and death in the absence of dialysis or a kidney transplant. While much of the research has focused on identifying etiology, this project seeks to ascertain factors associated with the rapidity of kidney disease progression in one of Sri Lanka's CKDu endemic areas. A sample of 296 male and female residents aged 21 to 65 with moderate CKD, as measured by their serum creatinine level, and a clinical diagnosis of CKDu are followed using quarterly serum testing to track the rate of progression. A baseline survey administered to the entire sample addresses potential risk factors, supplemented by a short survey focusing on changes through time. Concurrently water, soil and air are tested at the local and household levels. The study is the first to foster a multi-disciplinary approach that focuses on disease progression, identifying behavioural and exposure risk factors for rapid kidney function decline, in this progressively fatal disease.
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Affiliation(s)
- Penny Vlahos
- Department of Marine Sciences, University of Connecticut, Groton, CT, USA
| | | | - Nishantha Nanayakkara
- Faculty of Medicine, Kandy Teaching Hospital, University of Peradeniya, Kandy, Sri Lanka
| | | | - Lalarukh Haider
- School of Medicine, University of Connecticut, Storrs, CT, USA
| | - Shuchi Anand
- School of Medicine, Stanford University, Stanford, CA, USA
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Nanayakkara N, Pease AJ, Ranasinha S, Wischer N, Andrikopoulos S, de Courten B, Zoungas S. Younger people with Type 2 diabetes have poorer self-care practices compared with older people: results from the Australian National Diabetes Audit. Diabet Med 2018; 35:1087-1095. [PMID: 29729055 DOI: 10.1111/dme.13660] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 11/26/2022]
Abstract
AIM This cross-sectional study compares the self-care practices of younger and older people with Type 2 diabetes. METHODS Data were analysed from the Australian National Diabetes Audit (ANDA) including 2552 adults with Type 2 diabetes from Australian Diabetes Centres. Pre-specified demographic and clinical variables were obtained. Self-care variables (physical activity, following dietary recommendations, medication adherence and monitoring blood glucose levels) were compared in people ≤ 64 and > 64 years of age. RESULTS Mean age (± sd) of participants was 63 ± 13 years overall, 53 ± 9 years for the younger group and 73 ± 6 years for the older group. A greater proportion of younger people had HbA1c levels > 53 mmol/mol (> 7.0%) (76% vs. 68%), reported difficulty following dietary recommendations (50% vs. 32%) and forgetting medications (37% vs. 22%) compared with older people (all P-values <0.001). A smaller proportion of younger compared with older people reported monitoring their blood glucose levels as often as recommended (60% vs. 70%, P < 0.001). Similar proportions of people aged ≤ 64 and > 64 years required insulin therapy (59% vs. 57%, P = 0.200). Younger age was associated with a twofold increase in the odds of not following the recommended self-care practices after adjustment for gender, smoking, insulin therapy, depression and allied health attendance (all P < 0.001). CONCLUSIONS Despite shorter diabetes duration, younger age was associated with worse glycaemic control and poorer diabetes self-care practices among people with Type 2 diabetes. Targeted strategies are required to optimize diabetes self-care practices and thereby glycaemic control.
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Affiliation(s)
- N Nanayakkara
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| | - A J Pease
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| | - S Ranasinha
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - N Wischer
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- National Association Diabetes Centres, Sydney, Australia
| | - S Andrikopoulos
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- National Association Diabetes Centres, Sydney, Australia
| | - B de Courten
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| | - S Zoungas
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
- The George Institute for Global Health, Camperdown, New South Wales, Australia
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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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Ratnayake S, Badurdeen Z, Nanayakkara N, Abeysekara T, Ratnatunga N, Kumarasiri R. Screening for chronic kidney disease of uncertain aetiology in Sri Lanka: usability of surrogate biomarkers over dipstick proteinuria. BMC Nephrol 2017. [PMID: 28629425 PMCID: PMC5477244 DOI: 10.1186/s12882-017-0610-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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] [Indexed: 11/10/2022] Open
Abstract
Background The use of dipstick proteinuria to screen Chronic Kidney Disease of uncertain aetiology (CKDu) in Sri Lanka is a recently debated matter of dispute. The aim of this study was to assess the suitability of biomarkers: serum creatinine, cystatin C and urine albumin to creatinine ratio (ACR) for screening CKDu in Sri Lanka. Methods Forty-four male CKDu patients and 49 healthy males from a CKDu-endemic region were selected. Meanwhile, 25 healthy males from a non-endemic region were selected as an absolute control. The diagnostic accuracy of each marker was compared using the above three study groups. Results In receiver operating characteristics (ROC) plots for creatinine, cystatin C and ACR, values of area under the curve (AUC) were 0.926, 0.920 and 0.737 respectively when CKDu was compared to non-endemic control. When CKDu was compared to endemic control, AUCs of above three analytes were distinctly lower as 0.718, 0.808 and 0.678 respectively. Cystatin C exhibited the highest sensitivity for CKDu when analyzed against both control groups where respective sensitivities were 0.75 against endemic control and 0.89 against non-endemic control. ROC-optimal cutoff limits of creatinine, cystatin C and ACR in CKDu vs non-endemic control were 89.0 μmol/L, 1.01 mg/L and 6.06 mg/g-Cr respectively, whereas in CKDu vs endemic control the respective values were 111.5 μmol/L, 1.22 mg/L and 12.66 mg/g-Cr. Conclusions Amongst the three biomarkers evaluated in this study, our data suggest that Cystatin C is the most accurate functional marker in detecting CKDu in endemic regions, yet the high cost hinders its usability on general population. Creatinine is favorable over dipstick proteinuria owing to its apparent accuracy and cost efficiency, while having the ability to complement the kidney damage marker (ACR) in screening. ACR may not be favorable as a standalone screening marker in place of dipstick proteinuria due to its significant decline in sensitivity against the CKDu-endemic population. However, creatinine and ACR in a complementary manner could overcome current shortcomings of dipstick proteinuria and such a dual marker tool could be commodious in screening CKDu-type tubulointerstital diseases. Furthermore, use of ACR may also increase the ability to clinically discriminate CKDu from other glomerular nephropathies.
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Affiliation(s)
- Samantha Ratnayake
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. .,Sri Lanka Institute of Nanotechnology (SLINTEC), Homagama, Sri Lanka.
| | - Zeid Badurdeen
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Tilak Abeysekara
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ranjith Kumarasiri
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Gamage CD, Yoshimatsu K, Sarathkumara YD, Kulendiran T, Nanayakkara N, Arikawa J. Serological evidence of hantavirus infection in Girandurukotte, an area endemic for chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka. Int J Infect Dis 2017; 57:77-78. [PMID: 28212862 DOI: 10.1016/j.ijid.2017.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/15/2016] [Accepted: 02/05/2017] [Indexed: 10/20/2022] Open
Affiliation(s)
- Chandika D Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kumiko Yoshimatsu
- Department of Microbiology, Hokkaido University Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
| | - Yomani D Sarathkumara
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | - Jiro Arikawa
- Department of Microbiology, Hokkaido University Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
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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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Abeysekera RA, Wazil AWM, Nanayakkara N, Ratnatunga NVI, Fernando KM, Thinnarachchi J. Primary antiphospholipid syndrome presenting as antiphospholipid syndrome nephropathy: a case report. J Med Case Rep 2015; 9:28. [PMID: 25630456 PMCID: PMC4406029 DOI: 10.1186/1752-1947-9-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/15/2014] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Primary antiphospholipid syndrome can be a difficult diagnosis in the absence of typical clinical features. We describe an unusual presentation of primary antiphospholipid syndrome mimicking vasculitis for which the only diagnostic clue on initial presentation was antiphospholipid syndrome nephropathy. CASE PRESENTATION A 29-year-old Sri Lankan woman presented with features mimicking vasculitis with no obvious clinical features of antiphospholipid syndrome. Classical symptoms of antiphospholipid syndrome only appeared months later. A retrospective analysis showed that the only evidence of antiphospholipid syndrome at her first presentation was antiphospholipid syndrome nephropathy on her renal biopsy. CONCLUSIONS A high degree of suspicion of antiphospholipid syndrome is needed when patients present with non-specific vasculitis features. It has a broad clinical impact as antiphospholipid syndrome can present to any clinician with rare manifestations such as nephropathy. This significantly adds to the advancement of knowledge as antiphospholipid syndrome nephropathy should be recognized as a true entity and considered as a classification criteria for antiphospholipid syndrome.
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Affiliation(s)
- Rajitha Asanga Abeysekera
- Nephrology and Transplantation Unit, Teaching Hospital, No, 532/6 Siebel Place, Kandy 20000, Sri Lanka.
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Eatock MM, Tebbutt NC, Bampton CL, Strickland AH, Valladares-Ayerbes M, Swieboda-Sadlej A, Van Cutsem E, Nanayakkara N, Sun YN, Zhong ZD, Bass MB, Adewoye AH, Bodoky G. Phase II randomized, double-blind, placebo-controlled study of AMG 386 (trebananib) in combination with cisplatin and capecitabine in patients with metastatic gastro-oesophageal cancer. Ann Oncol 2012; 24:710-8. [PMID: 23108953 DOI: 10.1093/annonc/mds502] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We evaluated AMG 386, an investigational peptibody that neutralizes the interaction between angiopoietins-1 and -2 and the Tie2 receptor, combined with cisplatin/capecitabine (CX) as first-line treatment for metastatic gastro-oesophageal cancer. PATIENTS AND METHODS Patients with metastatic gastric, gastro-oesophageal junction, or distal oesophageal adenocarcinoma were randomized 1:1:1 to CX (cisplatin 80 mg/m(2) IV Q3W; capecitabine 1000 mg/m(2) P.O. BID for 14 days Q3W) plus intravenous AMG 386 10 mg/kg QW (Arm A) or 3 mg/kg QW (Arm B), or placebo QW (Arm C). The primary end point was estimated progression-free survival (PFS). RESULTS A total of 171 patients were enrolled. Median estimated PFS in Arms A, B, and C was 4.2, 4.9, and 5.2 months, respectively (hazard ratio for Arms A+B combined versus Arm C, 0.98; 95% CI 0.67-1.43; P = 0.92). Objective response rates were 27% (Arm A), 43% (Arm B), and 35% (Arm C). Incidence of grade ≥3 adverse events was 80% in Arm A, 84% in Arm B, and 75% in Arm C. There was no evidence of pharmacokinetic interactions. CONCLUSIONS In this study, PFS and ORR were estimated to be similar with AMG 386 plus CX and placebo plus CX treatment. Compared with placebo, toxicity of AMG 386 plus CX was greater but manageable. PREVIOUS PRESENTATION The results of this study have not been previously published or submitted for publication elsewhere. The results were presented in part at the Gastrointestinal Cancers Symposium, San Francisco, CA, January 20-22, 2011. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT00583674.
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Affiliation(s)
- M M Eatock
- Department of Oncology, Belfast City Hospital, Belfast BT9 7AB, Northern Ireland.
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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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Wenham R, Schilder R, Pippitt C, Wong S, Ananda S, Scudder S, Melara R, Nanayakkara N, Adewoye H, Vergote I. AMG 386 combined with either pegylated liposomal doxorubicin or topotecan in patients with advanced ovarian cancer: Results from a phase Ib study. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.079] [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: 11/29/2022]
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