Chronic kidney disease with unknown cause across the global spectrum

Abstract

Purpose of reviewIn the 1990s, a type of chronic kidney disease with unknown cause (CKDu) was identified in Central America and Sri Lanka. Patients lacked hypertension, diabetes, glomerulonephritis, or other usual causes of kidney failure. Affected patients are predominantly male agricultural workers aged 20--60 years, living in economically disadvantaged areas with poor access to medical care. Patients typically present late and progress to end-stage kidney disease within 5 years, resulting in social and economic hardship for families, regions, and countries. This review covers the current state of knowledge for this disease. Recent findingsThe prevalence of CKDu is increasing in known endemic regions and across the globe, reaching epidemic proportions. There is primary tubulointerstitial injury with secondary glomerular and vascular sclerosis. No definitive etiologic factors have been identified, and these may vary or overlap in different geographic locations. The leading hypotheses include exposure to agrochemicals, heavy metals and trace elements, and kidney injury from dehydration/heat stress. Infections and lifestyle factors may play a role, but are likely not key. Genetic and epigenetic factors are beginning to be explored. SummaryCKDu is a leading cause of premature death in young-to-middle-aged adults in endemic regions and has become a public health crisis. Studies are underway to investigate clinical, exposome, and omics factors, and hopefully will provide insights into pathogenetic mechanisms resulting in biomarker discovery, preventive measures, and therapeutics.

Association between Anxiety Status and Hydration Status in Spanish University Students

“…In other studies, the relationship between hypohydration status and degraded mood was consistent. The findings showed that low water intake or low 24 h urine volume is associated with negative health outcomes, including an increased risk of chronic kidney disease, the development of kidney stones, and altered glucose homeostasis [ 33 , 34 ]. In additional studies, measurements of self-reported changes in mental state consistently found associations between dehydration and mood in conjunction with changes in performance.…”