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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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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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Nanayakkara S, Senevirathna STMLD, Harada KH, Chandrajith R, Hitomi T, Abeysekera T, Muso E, Watanabe T, Koizumi A. Systematic evaluation of exposure to trace elements and minerals in patients with chronic kidney disease of uncertain etiology (CKDu) in Sri Lanka. J Trace Elem Med Biol 2019; 54:206-213. [PMID: 31109613 DOI: 10.1016/j.jtemb.2019.04.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 11/18/2018] [Revised: 04/03/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Abstract
Chronic kidney disease of uncertain etiology (CKDu) in areas in and around Sri Lanka's North Central Province has been identified as a major non-communicable disease due to its high prevalence and the burden on the public health system. Controversial evidence relating to the etiology and risk factors of CKDu has been reported. The most debated is the role of trace elements such as Cd and As in the pathogenesis of CKDu. Urine and hair samples collected from CKDu patients and healthy controls were measured for the concentration of different elements including Cd and As. To assess the possible environmental exposures, drinking water and rice samples collected from the affected areas as well as unaffected areas in the country were analyzed. Transmission electronic microscopic analysis of renal biopsies from CKDu patients was also performed. Analysis of drinking water and rice samples indicated that the levels of all minerals and trace elements analyzed including Cd and As were within the levels recommended by World Health Organization and Sri Lanka drinking water guidelines and did not suggest any form of contamination. Analysis of biological samples, including urine, hair and renal tissue, did not provide evidence to support Cd or As toxicity in CKDu patients. Overall, the observations of this integrated, comprehensive study, which included biological, environmental and pathological investigations, strongly support our previous reports on the absence of Cd and As toxicity in areas with high prevalence of CKDu. Further, these observations do not provide evidence on the involvement of Cd and As in pathogenesis of CKDu in Sri Lanka.
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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
- CSU Engineering, Faculty of Business, Justice and Behavioural Sciences, 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
| | - Toshiaki Hitomi
- Department of Preventive Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tilak Abeysekera
- Department of Pharmacology, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Eri Muso
- Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Institute, Osaka, Japan
| | - Takao Watanabe
- Faculty of Child Education, Tohoku Bunkyo University, Yamagata, Japan
| | - Akio Koizumi
- Institute of Public Health and Welfare Research, Nakagyoku, Kyoto, Japan
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BADURDEEN Z, Hemage R, Fernando B, Hettiarachchi- T, Dharmasiri T, Ratnatunga N, Abeysekera T, Abeysundara H, Hettipolage S, Nishantha N. SAT-176 A PILOT STUDY: MANIFESTATION OF CANDIDATE RENAL BIOMARKERS IN PATIENTS WITH CHRONIC KIDNEY DISEASE OF UNCERTAIN ETIOLOGY. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Sayanthooran S, Magana-Arachchi DN, Gunerathne L, Abeysekera T. Potential diagnostic biomarkers for chronic kidney disease of unknown etiology (CKDu) in Sri Lanka: a pilot study. BMC Nephrol 2017; 18:31. [PMID: 28103909 PMCID: PMC5244589 DOI: 10.1186/s12882-017-0440-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/06/2017] [Indexed: 12/23/2022] Open
Abstract
Background In Sri Lanka, there exists chronic kidney disease of both known (CKD) and unknown etiologies (CKDu). Identification of novel biomarkers that are customized to the specific causative factors would lead to early diagnosis and clearer prognosis of the diseases. This study aimed to find genetic biomarkers in blood to distinguish and identify CKDu from CKD as well as healthy populations from CKDu endemic and non-endemic areas of Sri Lanka. Methods The expression patterns of a selected panel of 12 potential genetic biomarkers were analyzed in blood using RT-qPCR. Fold changes of gene expressions in early and late stages of CKD and CKDu patients, and an apparently healthy population of a CKDu endemic area, Girandurukotte (GH) were calculated relative to apparently healthy volunteers from a CKDu non-endemic area, Kandy (KH) of Sri Lanka, using the comparative CT method. Results Significant differences were observed between KH and early stage CKDu for both the insulin-like growth factor binding protein 1 (IGFBP1; p = 0.012) and kidney injury molecule-1 (KIM1; p = 0.003) genes, and KH and late stage CKD and CKDu for the glutathione-S-transferase mu 1 (GSTM1; p < 0.05) gene. IGFBP1 and KIM1 genes showed significant difference between the early and late stage CKDu (p < 0.01). The glutamate cysteine ligase catalytic subunit (GCLC) gene had significantly different expression between KH and all the other study groups (p < 0.01). The GH group was significantly different from the KH group for the oxidative stress related genes, G6PD, GCLC and GSTM1 (p < 0.01), and also the KIM1 gene (p = 0.003). IGFBP1, insulin-like growth factor binding protein 3 (IGFBP3), fibronectin 1 (FN1) and KIM1 showed significant correlations with serum creatinine, and IGFBP1, KIM1 and kallikrein 1 (KLK1) with eGFR (p < 0.05). Conclusion A panel consisting of IGFBP1, KIM1, GCLC and GSTM1 genes could be used in combination for early screening of CKDu, whereas these genes in addition with FN1, IGFBP3 and KLK1 could be used to monitor progression of CKDu. The regulation of these genes has to be studied on larger populations to validate their efficiency for further clinical use.
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Affiliation(s)
| | | | | | - Tilak Abeysekera
- Department of Pharmacology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
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Kabata R, Nanayakkara S, Senevirathna S, Harada KH, Chandrajith R, Hitomi T, Abeysekera T, Takasuga T, Koizumi A. Neonicotinoid concentrations in urine from chronic kidney disease patients in the North Central Region of Sri Lanka. J Occup Health 2016; 58:128-33. [DOI: 10.1539/joh.15-0140-br] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Risako Kabata
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Shanika Nanayakkara
- Faculty of DentistryThe University of Sydney, Westmead Centre for Oral Health, Westmead HospitalAustralia
| | | | - Kouji H. Harada
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Rohana Chandrajith
- Department of Geology, Faculty of ScienceUniversity of PeradeniyaSri Lanka
| | - Toshiaki Hitomi
- Department of Preventive Medicine, Faculty of MedicineSt. Marianna University School of MedicineJapan
| | - Tilak Abeysekera
- Department of Pharmacology, Faculty of MedicineUniversity of PeradeniyaSri Lanka
| | | | - Akio Koizumi
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
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Kabata R, Nanayakkara S, Senevirathna S, Harada KH, Chandrajith R, Hitomi T, Abeysekera T, Takasuga T, Koizumi A. Neonicotinoid concentrations in urine from chronic kidney disease patients in the North Central Region of Sri Lanka. J Occup Health 2015. [PMID: 26549834 DOI: 10.1539/joh.15‐0140‐br] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Neonicotinoid insecticides have been widely used around the world since the 1990s. Reports have been made since the 1990s of rice paddy farmers in the North Central Region (NCR) of Sri Lanka suffering from chronic kidney disease with unknown etiology (CKDu). A preliminary evaluation of the exposure of local farmers in the NCR of Sri Lanka to neonicotinoids was performed. METHODS We analyzed neonicotinoid and neonicotinoid metabolite concentrations in spot urine samples. We selected 40 samples, 10 from farmers with CKDu and 10 from controls from each of two areas, Medawachchiya and Girandurukotte. RESULTS Imidacloprid and desmethyl-acetamiprid were found at significantly higher concentrations in the control samples (with medians of 51 ng/l and 340 ng/l, respectively) than in the CKDu samples (medians of 15 ng/l and 150 ng/l, respectively) when the results were not adjusted for the creatinine contents. None of the six compounds that were measured in the urine samples were found at significantly higher concentrations in the CKDu samples than in the control samples. None of the neonicotinoid concentrations in the samples analyzed in this study exceeded the concentrations that have been found in samples from the general population of Japan. CONCLUSIONS Farmers (both with and without CKDu) living in CKDu-endemic areas in the NCR of Sri Lanka are exposed to lower neonicotinoid concentrations than non-occupationally exposed residents of Japan.
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Affiliation(s)
- Risako Kabata
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University
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Nanayakkara S, Senevirathna STMLD, Abeysekera T, Chandrajith R, Ratnatunga N, Gunarathne EDL, Yan J, Hitomi T, Muso E, Komiya T, Harada KH, Liu W, Kobayashi H, Okuda H, Sawatari H, Matsuda F, Yamada R, Watanabe T, Miyataka H, Himeno S, Koizumi A. An Integrative Study of the Genetic, Social and Environmental Determinants of Chronic Kidney Disease Characterized by Tubulointerstitial Damages in the North Central Region of Sri Lanka. J Occup Health 2014; 56:28-38. [DOI: 10.1539/joh.13-0172-oa] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shanika Nanayakkara
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
- Institute of Dental Research, Westmead Centre for Oral Health, Faculty of DentistryThe University of SydneyAustralia
| | - STMLD Senevirathna
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
- School of Computing, Engineering and Mathematics, University of Western SydneyAustralia
| | - Tilak Abeysekera
- Department of Pharmacology, Faculty of MedicineUniversity of PeradeniyaSri Lanka
| | - Rohana Chandrajith
- Department of Geology, Faculty of ScienceUniversity of PeradeniyaSri Lanka
| | | | | | - Junxia Yan
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Toshiaki Hitomi
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Eri Muso
- Department of Nephrology and DialysisTazuke Kofukai Medical Research Institute, Kitano HospitalJapan
| | - Toshiyuki Komiya
- Department of Nephrology and DialysisTazuke Kofukai Medical Research Institute, Kitano HospitalJapan
| | - Kouji H. Harada
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Wanyang Liu
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Hatasu Kobayashi
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Hiroko Okuda
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | | | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto UniversityJapan
| | - Ryo Yamada
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto UniversityJapan
| | | | - Hideki Miyataka
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical SciencesTokushima Bunri UniversityJapan
| | - Seiichiro Himeno
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical SciencesTokushima Bunri UniversityJapan
| | - Akio Koizumi
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
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Nanayakkara S, Senevirathna STMLD, Abeysekera T, Chandrajith R, Ratnatunga N, Gunarathne EDL, Yan J, Hitomi T, Muso E, Komiya T, Harada KH, Liu W, Kobayashi H, Okuda H, Sawatari H, Matsuda F, Yamada R, Watanabe T, Miyataka H, Himeno S, Koizumi A. An integrative study of the genetic, social and environmental determinants of chronic kidney disease characterized by tubulointerstitial damages in the North Central Region of Sri Lanka. J Occup Health 2013. [PMID: 24351856 DOI: 10.1539/joh.13‐0172‐oa] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Previous investigations on chronic kidney disease of unknown etiology characterized by tubulointerstitial damages (CKDu) in the North Central Region (NCR) of Sri Lanka have supported the involvement of social, environmental and genetic factors in its pathogenesis. METHODS We conducted a social-environmental-and-genetic epidemiology study on a male population in NCR to investigate the genetic and environmental contributors. We recruited 311 case-series patients and 504 control candidates. Of the 504 control candidates, 218 (43%) were eliminated because of the presence of hypertension, proteinuria, high HbA1c, high serum creatinine or high alpha-1 microglobulin in urine. RESULTS AND DISCUSSION None of 18 metals measured (μg//) in urine, including Cd, As and Pb, showed significantly higher concentrations in cases compared with controls. As speciation results showed that 75-80% of total urinary As was in the form of arsenobetaine, which is non-toxic to humans. None of the metal concentrations in drinking water samples exceeded guideline values. A genome-wide association study (GWAS) was conducted to determine the genetic contributors. The GWAS yielded a genome-wide significant association with CKDu for a single nucleotide polymorphism (SNP; rs6066043; p=5.23 × 10(-9) in quantitative trait locus analysis; p=3.73 × 10(-9) in dichotomous analysis) in SLC13A3 (sodium-dependent dicarboxylate transporter member 3). The population attributable fraction and odds ratio for this SNP were 50% and 2.13. Genetic susceptibility was identified as the major risk factor for CKDu. However, 43% of the apparently healthy male population suffers from non-communicable diseases, suggesting their possible influence on CKDu progression.
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Affiliation(s)
- Shanika Nanayakkara
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University
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Senevirathna L, Abeysekera T, Nanayakkara S, Chandrajith R, Ratnatunga N, Harada KH, Hitomi T, Komiya T, Muso E, Koizumi A. Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka. Environ Health Prev Med 2011; 17:191-8. [PMID: 21881957 DOI: 10.1007/s12199-011-0237-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [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: 07/11/2011] [Accepted: 08/08/2011] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The alarming rise in the prevalence of chronic kidney disease of uncertain etiology (CKDu) among the low socioeconomic farming community in the North Central Province of Sri Lanka has been recognized as an emerging public health issue in the country. METHODS This study sought to determine the possible factors associated with the progression and mortality of CKDu. The study utilized a single-center cohort registered in 2003 and followed up until 2009 in a regional clinic in the endemic region, and used a Cox proportional hazards model. RESULTS We repeatedly found an association between disease progression and hypertension. Men were at higher risk of CKDu than women. A significant proportion of the patients in this cohort were underweight, which emphasized the need for future studies on the nutritional status of these patients. CONCLUSIONS Compared with findings in western countries and other regions of Asia, we identified hypertension as a major risk factor for progression of CKDu in this cohort.
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Affiliation(s)
- Lalantha Senevirathna
- Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Desalegn B, Nanayakkara S, Harada KH, Hitomi T, Chandrajith R, Karunaratne U, Abeysekera T, Koizumi A. Mycotoxin detection in urine samples from patients with chronic kidney disease of uncertain etiology in Sri Lanka. Bull Environ Contam Toxicol 2011; 87:6-10. [PMID: 21553028 DOI: 10.1007/s00128-011-0301-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 04/29/2011] [Indexed: 05/30/2023]
Abstract
This was a screening study that aimed to determine the presence of nephrotoxic mycotoxins in urine samples from patients with chronic kidney disease of uncertain etiology in the North Central Province of Sri Lanka. The percentage detection of aflatoxins, ochratoxins and fumonisins in 31 patients were 61.29%, 93.5% and 19.4%, respectively. Geometric means of urinary aflatoxins and ochratoxins were 30.93 creatinine and 34.62 ng/g creatinine in chronic kidney disease of uncertain etiology stage 1-2 patients and 84.12 ng/g creatinine and 63.52 ng/g creatinine in unaffected relatives of patients. In chronic kidney disease of uncertain etiology stage 3-5 patients, geometric means of urinary aflatoxins and ochratoxins were 10.40 and 17.08 ng/g creatinine, respectively. Non-affected relatives of patients (n = 6) had comparable levels of these mycotoxins, but healthy Japanese individuals (n = 4) had lower levels than in Sri Lanka. The higher detection rate of urinary ochratoxins in Sri Lankans indicates that exposure is common in the region.
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Affiliation(s)
- Biruck Desalegn
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoe, Sakyo, Kyoto 606-8501, Japan
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Abeysekera T, Wickremasinghe AR, Gunawardena DM, Mendis KN. Optimizing the malaria data recording system through a study of case detection and treatment in Sri Lanka. Trop Med Int Health 1997; 2:1057-67. [PMID: 9391508 DOI: 10.1046/j.1365-3156.1997.d01-183.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The potential of using malaria incidence data routinely collected from endemic regions for disease control and research has increased with the availability of advanced computer-based technologies, but will depend on the quality of the data itself. We report here an investigation into the relevance of malaria statistics provided by the routine data collection system in Moneragala, a rural malaria-endemic region in Sri Lanka. All patients (n = 321) treated for malaria in 2 clusters of health care centres (HCCs) of both the private and the public sector in the administrative regions of Moneragala and Buttala Divisional Secretariat (D.S.). Divisions were studied in December 1995/ January 1996. The catchment area of these HCCs included a population resident in 53 Grama Niladhari (GN) areas, the smallest administrative units of the country. Almost equal numbers of malaria patients were detected and treated at Government and private health care institutions, and in 70% of them treatment was based on a diagnosis confirmed by microscopy. The routine data recording system, however, included only statistics from the Government sector, and only of patients whose diagnosis was microscopically confirmed. In compiling data, the origin of a case of malaria is attributed to the D.S. Division in which the institution (at which the patient was treated) was located, rather than the area in which the patient was resident, which was inaccurate because 90% of malaria patients sought health care at institutions located closest to their residence, thus crossing administrative boundaries. It also led to a loss of resolution of spatial data because patients' addresses recorded at the Government HCCs to the village-level are replaced in the statistics by the D.S. Division, which is a coarse spatial unit. Modifications to the system for malaria case recording needed to correct these anomalies are defined here. If implemented, these could result in major improvements to the quality of data, a valuable resource for the future of malaria control. The paper reiterates the call for the use of a standard spatial unit within a country to facilitate exchange of data among health and other sectors for the control of tropical diseases.
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Affiliation(s)
- T Abeysekera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka
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