Acronyms, CINAC, ACN, KDUCAL or NUCAL and so on are inappropriate to use for describing CKDu

Ileperuma, O.A.; Weeraratne, Stanley; Wimalawansa, Sunil J.

doi:10.1136/jech-2018-210959

Cited by 6 publications

(2 citation statements)

References 7 publications

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“…People who have no connection with agriculture or agrochemicals also get the disease if the conditions are right. Consequently, agricultureor agrochemical-based derogative terminology and acronyms should not be used to describe this disease (Ileperuma et al, 2018). The present findings enable respective administrations and charitable foundations to provide cost-effective modalities to prevent renal damage and reverse the early renal failure of this fatal disease.…”

Section: Discussionmentioning

confidence: 95%

CaPO4-Mediated CKD of Crystallo-Tubular-Nephropathy [CKD-CTN]—A Crystal and Nanotube-Induced Geo-Environmental Disease

Wimalawansa¹,

Dissanayake²

2022

Front. Water

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ImportanceMore than forty million people from certain tropical countries are at risk of developing a non-conventional form of chronic kidney disease (CKD), CKD of multifactorial etiology (CKDmfo). This is also known as CKD of unknown etiology (CKDu). Worldwide, it kills more than 20,000 people annually.FindingsCKDmfo is a chronic tubulointerstitial renal disease caused by groundwater-induced hydroxy- and fluorapatite nano-crystals and nano-tube formation in renal tubules and cortical tissues, in conjunction with chronic intravascular volume depletion, chronic renal anaemia, and ischemia. To manifest this gradually developing renal failure, consuming hard water having, higher concentrations of calcium, phosphates, and fluoride for more than 10 years is necessary. The disease progresses when the kidneys fail to repair or due to ongoing renal tissue damage in the presence of micronutrient deficiency, chronic dehydration, renal ischemia, chronic inflammation, and oxidative stress. These prevents regenerations of renal tissues.ConclusionConsumption of stagnant groundwater concentrated with ions, like Ca2+, PO4, and F− due to prolonged annual droughts over many years, in conjunction with lesser water intake and chronic dehydration, creates a conducive internal milieu for CaPO4 crystallisation in renal tissues. This proposed primary etiology of the crystal-tubular-nephropathy (CTN) provides an insight into a deeper understanding of the use of cost-effective strategies for prevention, early intervention, and eradication of CKD-CTN. In addition to the nano-crystal/nano-tube concept, we provide supporting scientific evidence that Mg2+ in water and the diet does not promote the disease; instead, it prevents crystal formation and developing CKDmfo, as with some other CKDs.RelevanceWe present novel CaPO4 hydroxyapatite crystal formation concepts in a hyperosmolar fluid in renal tissues that causes CKDmfo. Besides, the protective (e.g., magnesium) and enhancing (e.g., dehydration, drinking stagnant hard water) mechanisms that cause CKD-CTN are explored. A new understanding of causative mechanisms paves a path for cost-effective targeted interventions to prevent and eliminate CKDmfo. These principles apply to all CKDmfo/CKDu-affected countries to protect the renal health of farm labourers and others who regularly engage in physical work in hot and dry environments. Providing affordable potable water, increasing water consumption, and avoiding harmful behaviours are critical measures for eliminating CKDmfo.

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Section: Discussionmentioning

confidence: 95%

CaPO4-Mediated CKD of Crystallo-Tubular-Nephropathy [CKD-CTN]—A Crystal and Nanotube-Induced Geo-Environmental Disease

Wimalawansa¹,

Dissanayake²

2022

Front. Water

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“…However, it neither exclusively affects agricultural communities nor is it related to agrochemicals. Those who were never involved with agriculture and engaged in other professions also developed this fatal CKD; what matters are their location and drinking water source—the quality of water, and behaviour [ 2 ]. There is no affirmative and reliable scientific evidence that fertilisers, arsenic, pesticides, arsenic, heavy metals, algae toxins, genetic susceptibility, ayurvedic or traditional medications, other known chemical nephrotoxins, or direct human interventions cause CKD–CTN [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Nanocrystal-induced chronic tubular-nephropathy in tropical countries: diagnosis, mitigation, and eradication

Wimalawansa

Dissanayake

2023

Eur J Med Res

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In tropical countries, a mysterious tubulo-interstitial chronic renal disease (CKD), unrelated to diabetes, hypertension, and immunological causes, manifested four decades ago. Approximately 25,000 primarily middle-aged male farmers succumb annually to this crystal-tubular nephropathy (CTN). Without any known causative factors, it was identified as CKD of unknown aetiology (CKDu). Because multiple factors contribute to causing it later, was changed to CKD of multi-factorial (CKDmfo). Despite no evidence, it was hypothesised to cause by agrochemicals or heavy metals in food or drinking contaminated water. However, current data suggest that the CKD-CTN is due to natural geogenic water contamination. Consumption of concentrated stagnant groundwater from deep-dug wells and tube wells containing hard water and fluoride, overdecades is necessary for its clinical manifestations. In all affected countries have prolonged annual dry seasons that led to the evopo-concentration of ions and minerals in groundwater, making hard water even more unpalatable, thus, peasants consume lesser amounts of water. They develop chronic dehydration from daily exposure to hot climatic conditions aggravated by regular alcohol intake. These conditions provide a highly conducive environment—a perfect storm for calcium phosphate (CaPO4) crystal formation in renal tissues. Our recent histological and preliminary electron microscopic data reveal deposition of CaPO4 crystals and nano-tubes in kidneys. While CaPO4 nano-minerals are unstable, the presence of fluoride ions stabilises and allows their growth. This new concept paves the path for highly cost-effective, straightforward local solutions to protect farm workers and eliminate the disease, without embarking on expensive medications, interventions, or building hospitals. Chronic dehydration-associated CKD–CTN is preventable by increased consumption of potable water. Increasing clean water consumption reduces CKD–CTN incidence, and associated morbidities and premature deaths. However, the damage becomes irreversible when the disease advances beyond CKD stage IIIB. The incidence of this deadly renal failure can be prevented by its education, lifestyle changes, and increased water consumption, not by treating the renal disease or expanding dialysis centres/hospitals, or transplantation services. Eradication of CKD-CTN cost significantly less than the current approach of treating affected persons and unnecessarily expanding health infrastructure. Since the manifestation of CKD-CTN is due to consuming naturally contaminated drinking water (with calcium containing hard water and fluoride), it is not difficult to remove these to prevent CKD-CTN: thus, international assistance is unwarranted for its eradication. The straightforward approaches described here will prevent CKD–CTN and save thousands of lives in affected farming communities.

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Renal tubular lysosomal vacuoles are a generic toxic manifestation and not particularly associated with agrochemicals and heavy metal toxicity or specific to a disease

Wimalawansa¹

2020

Kidney International

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Acronyms, CINAC, ACN, KDUCAL or NUCAL and so on are inappropriate to use for describing CKDu

Cited by 6 publications

References 7 publications

CaPO4-Mediated CKD of Crystallo-Tubular-Nephropathy [CKD-CTN]—A Crystal and Nanotube-Induced Geo-Environmental Disease

CaPO4-Mediated CKD of Crystallo-Tubular-Nephropathy [CKD-CTN]—A Crystal and Nanotube-Induced Geo-Environmental Disease

Nanocrystal-induced chronic tubular-nephropathy in tropical countries: diagnosis, mitigation, and eradication

Renal tubular lysosomal vacuoles are a generic toxic manifestation and not particularly associated with agrochemicals and heavy metal toxicity or specific to a disease

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