The authors reply

“Dysmorphic” lysosomes in proximal tubular cells are not specific for CINAC/CKDu and do not provide evidence that CINAC/CKDu is a toxin-induced disease

“…The authors also claim that patients are prone to infections, but this has not been reported. 3 Consequently, contrary to the author's hypothesis, these lysosomes are not specific for toxicity, a link to a calcineurin inhibitor toxicity pathway is not evident, and a connection to pesticides is even more questionable.…”

“…To the editor: I read with interest the letter by Wimalawansa 1 commenting on the article by Vervaet et al 2 and their response. 3 Vervaet et al reiterate that the main message of their article is the hard evidence of a toxic etiology to chronic interstitial nephritis of agricultural communities (CINAC)/ chronic kidney disease of unknown cause (CKDu), although there has been no previous cellular evidence. Although Wimalawansa seems to concede that CINAC is likely a toxic nephropathy, his usage of the term "lysosomal vacuolation" clearly misinterprets the description of the CINAC lysosomal inclusions, which seem to be unique to some toxic nephropathies and not others.…”