Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka

Abstract

Chronic kidney disease of uncertain etiology (CKDu) in North Central Province of Sri Lanka has become a key public health concern in the agricultural sector due to the dramatic rise in its prevalence and mortality among young farmers. Although cadmium has been suspected as a causative pathogen, there have been controversies. To date, the pathological characteristics of the disease have not been reported. Histopathological observations of 64 renal biopsies obtained at Anuradhapura General Hospital from October 2008 to July 2009 were scored according to Banff 97 Working Classification of Renal Allograft pathology. The correlations between the histological observations and clinical parameters were statistically analyzed. Interstitial fibrosis and tubular atrophy with or without nonspecific interstitial mononuclear cell infiltration was the dominant histopathological observation. Glomerular sclerosis, glomerular collapse, and features of vascular pathology such as fibrous intimal thickening and arteriolar hyalinosis were also common. Although hypertension was identified as one of the common clinical features among the cases, it did not influence the histopathological lesions in all the cases. This study concludes that tubulointerstitial damage is the major pathological lesion in CKDu. Exposure(s) to an environmental pathogen(s) should be systematically investigated to elucidate such tubulointerstitial damage in CKDu.

Ingestion of dug well water from an area with high prevalence of chronic kidney disease of unknown etiology (CKDu) and development of kidney and liver lesions in rats

“…Most prominent kidney lesions were mild to moderate focal chronic inflammatory cell infiltrates in the renal interstitium. Interstitial fibrosis and tubular atrophy with or without nonspecific interstitial mononuclear cell infiltration are the most prominent lesion in human patients [17].…”

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

“…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 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].…”

Escalating chronic kidney diseases of multi-factorial origin (CKD-mfo) in Sri Lanka: causes, solutions, and recommendations—update and responses

“…All scientific evidence available to date including the WHO study [6][7][8][9][10], points to the involvement of multiple factors related to water pollution in precipitating this particular type of renal failure [1][2][3]12], which further supports the correct terminology for this disease, as CKD of multifactorial origin (CKD-mfo).…”