Prevalence of chronic kidney disease in two tertiary care hospitals: high proportion of cases with uncertain aetiology

Athuraliya, T. N. C.; Abeysekera, D T; Amerasinghe, Priyanie H.; Kumarasiri, P. V. R.; Dissanayake, Vajira H. W.

doi:10.4038/cmj.v54i1.471

Cited by 88 publications

(98 citation statements)

References 5 publications

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“…Chronic kidney disease of unknown aetiology (CKDu), which emerged at the beginning of this century, has reached epidemic proportions in the North Central Dry Zone of Sri Lanka [1,2]. The disease burden is most prominent in the North Central Province and has extended to two adjacent provinces, namely, Uva and North Western provinces.…”

Section: Introductionmentioning

confidence: 99%

Novel urinary biomarkers and their association with urinary heavy metals in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study

et al. 2017

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Introduction Chronic kidney disease of unknown etiology (CKDu) has emerged as a significant public health problem in Sri Lanka. The role of environmental exposure to cadmium and arsenic in the aetiology of CKDu is still unclear. Identification of a panel of novel urinary biomarkers would be invaluable in the study of toxin mediated damage postulated to be the aetiology of CKDu.Objectives The aims of this study were to evaluate the profile of novel urinary biomarkers in CKDu patients and identify any association with environmental exposure to heavy metals.Methods Thirty seven randomly selected CKDu patients attending a renal clinic in the North Central Province and two control groups namely a farmer group (n=39) and a non-farmer group (n=40) from a non-endemic area were included in this comparative cross sectional study. Urine samples were analyzed for heavy metals and five urinary biomarkers.Results CKDu patients had significantly elevated urinary levels of fibrinogen (198.2 ng/mg creatinine p<0.001), clusterin (3479 ng/mg creatinine p<0.001), cystatin-C (5124.8 ng/mg creatinine p<0.001) and β2-microglobulin (9913.4 ng/mg creatinine p<0.001) compared to the control groups. Fibrinogen and β2-microglobulin were the best to discriminate CKDu patients from normal individuals with the receiver operator areas under the curve being 0.867 and 0.853, respectively. Urinary fibrinogen and KIM-1 levels correlated positively with urinary arsenic levels. KIM-1 levels correlated positively with urinary mercury and lead levels but no correlation was seen with urinary cadmium levels.Conclusions Fibrinogen and β2-microglobulin have the potential of being a screening tool for detection of CKDu and may aid the early diagnosis of toxin mediated tubular injury in CKDu. Their usefulness need to be further validated in a larger epidemiological study of patients with early stages of CKDu. IntroductionChronic kidney disease of unknown aetiology (CKDu), which emerged at the beginning of this century, has reached epidemic proportions in the North Central Dry Zone of Sri Lanka [1,2]. The disease burden is most prominent in the North Central Province and has extended to two adjacent provinces, namely, Uva and North Western provinces. The disease is not due to conventional risk factors such as diabetes, hypertension, chronic glomerulonephritis. The diagnosis of CKDu is based on exclusion of known aetiological factors of chronic kidney disease and presence of tubulo-interstitial pathology on renal biopsy [3,4].The population in the North Central Province is around 2.5 million according to the last census conducted in 2012 and farming is the main livelihood of the majority. CKDu mainly affects farming communities with poor socioeconomic background [5]. The estimated prevalence of CKDu in a community based study was reported as 16.9% in women and 12.9% in men, but the severe stages were seen more frequently in men, leading to a higher mortality and morbidity in men [5,6].Based on CKDu's clinical profile and risk factors, it was postulate...

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Section: Introductionmentioning

confidence: 99%

Novel urinary biomarkers and their association with urinary heavy metals in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study

et al. 2017

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“…The North Central Province (NCP) in the dry zone of Sri Lanka has a total land area of 10,472 km 2 and is occupied by about 1.1 million people [1]. The prevalence of an endemic condition of chronic kidney disease (CKD) has dramatically increased over the past 15 years, affecting the low socioeconomic level farming community in the NCP [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of an endemic condition of chronic kidney disease (CKD) has dramatically increased over the past 15 years, affecting the low socioeconomic level farming community in the NCP [2][3][4][5]. Recently, the disease has also been identified in two neighboring provinces, North Western Province and Uva Province (Fig.…”

Section: Introductionmentioning

confidence: 99%

Evidence of tubular damage in the very early stage of chronic kidney disease of uncertain etiology in the North Central Province of Sri Lanka: a cross-sectional study

Nanayakkara

Senevirathna

Karunaratne

et al. 2011

Environ Health Prev Med

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Background In the North Central Province of Sri Lanka, chronic kidney disease of uncertain etiology (CKDue) has increased markedly over the past 15-20 years. Methods From around 4,700 patients who were followed up, 106 affected patients who visited two local clinics in the endemic area for CKDue on August 10, 2009 and 10 pedigrees of 10 of these cases with familial clustering of CKDue participated in this study. Urine samples, collected from affected patients (n = 106), unaffected relative controls (n = 81), and Japanese controls (n = 50), were analyzed for two tubular markers: a1-microglobulin and N-acetyl-b-D-glucosaminidase. Urine samples from patients with CKDue stages 1-4 (n = 101) and all the samples from unaffected relatives and Japanese controls were analyzed for urinary cadmium concentration. Results Urinary excretion of a1-microglobulin was elevated even in the earliest stage of CKDue compared with its levels in unaffected relative controls. Urinary excretion of N-acetyl-b-D-glucosaminidase was elevated only in stage 5. In contrast, urinary cadmium excretion was similar in CKDue patients and in the unaffected relative controls, and levels in both these groups were significantly lower than the level in the Japanese controls. All levels were below the threshold level for renal toxicity, indicating the absence of any evidence of cadmium toxicity. Conclusions The present study indicates that renal tubular damage occurs in the very early stage of CKDue and demonstrates the existence of familial clustering,

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“…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 7) . Local medical specialists claim that diabetes mellitus, hypertension, and other identifiable causes of CKD are not responsible for CKD in this region, and because the CKD pathogenesis is unknown, it has been called CKD of unknown etiology (CKDu).…”

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confidence: 59%

Neonicotinoid concentrations in urine from chronic kidney disease patients in the North Central Region of Sri Lanka

Kabata

Nanayakkara

Senevirathna

et al. 2016

Journal of Occupational Health

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Prevalence of chronic kidney disease in two tertiary care hospitals: high proportion of cases with uncertain aetiology

Cited by 88 publications

References 5 publications

Novel urinary biomarkers and their association with urinary heavy metals in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study

Novel urinary biomarkers and their association with urinary heavy metals in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study

Evidence of tubular damage in the very early stage of chronic kidney disease of uncertain etiology in the North Central Province of Sri Lanka: a cross-sectional study

Neonicotinoid concentrations in urine from chronic kidney disease patients in the North Central Region of Sri Lanka

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