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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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