Attempts to Change the Globally Accepted Term, CKDu, to KDUCAL, NUCAL, or CINAC Are Inappropriate

Abstract

We are concerned about the suggestion by Drs Subramanian and Javaid in AJKD1Subramanian S. Javaid M.M. Kidney disease of unknown cause in agricultural laborers (KDUCAL) is a better term to describe regional and endemic kidney diseases such as Uddanam nephropathy [letter].Am J Kidney Dis. 2017; 69: 552Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar and elsewhere2Subramanian S. Javaid M.M. Should we consider renaming ‘Mesoamerican nephropathy’ as nephropathy of unknown cause in agricultural labourers (NUCAL)?.Occup Environ Med. 2016; 73: 802PubMed Google Scholar to replace the term chronic kidney disease (CKD) of unknown origin (CKDu), which affects Sri Lanka and several tropical countries, with “kidney disease of unknown cause in agricultural laborers” (KDUCAL) and to replace Mesoamerican nephropathy (MeN) with “nephropathy of unknown cause in agricultural laborers” (NUCAL). These terms, as well as chronic interstitial nephritis in agricultural communities (CINAC)3Jayasumana C. Orantes C. Herrerra R. et al.Chronic interstitial nephritis in agricultural communities: a worldwide epidemic with social, occupational and environmental determinants.Nephrol Dial Transplant. 2017; 32: 234-241PubMed Google Scholar and “agrochemical nephropathy,”4Jayasinghe S. Chronic kidney disease of unknown etiology should be renamed chronic agrochemical nephropathy.MEDICC Rev. 2014; 16: 72-74PubMed Google Scholar imply that CKDu affects only agricultural laborers exposed to agrochemicals. This is incorrect because it affects diverse populations.5Wimalawansa S.J. The role of ions, heavy metals, fluoride, and agrochemicals: critical evaluation of potential aetiological factors of chronic kidney disease of multifactorial origin (CKDmfo/CKDu) and recommendations for its eradication.Environ Geochem Health. 2015; 38: 639-678Crossref PubMed Scopus (65) Google Scholar, 6Elinder C.-G. Wernerson A. Wijkström J. CINAC is not an appropriate name for the CKDu epidemic in Central America [letter].Nephrol Dial Transplant. 2017; 32: 234-241PubMed Google Scholar, 7Wijkström J. Leiva R. Elinder C.G. et al.Clinical and pathological characterization of Mesoamerican nephropathy: a new kidney disease in Central America.Am J Kidney Dis. 2013; 62: 908-918Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar Agrochemical toxicity as the cause of CKDu was eliminated based on a lack of scientific evidence following water, soil, and food analysis.5Wimalawansa S.J. The role of ions, heavy metals, fluoride, and agrochemicals: critical evaluation of potential aetiological factors of chronic kidney disease of multifactorial origin (CKDmfo/CKDu) and recommendations for its eradication.Environ Geochem Health. 2015; 38: 639-678Crossref PubMed Scopus (65) Google Scholar, 7Wijkström J. Leiva R. Elinder C.G. et al.Clinical and pathological characterization of Mesoamerican nephropathy: a new kidney disease in Central America.Am J Kidney Dis. 2013; 62: 908-918Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar Although agrochemicals may contribute, no scientific data support them as the cause of CKDu.5Wimalawansa S.J. The role of ions, heavy metals, fluoride, and agrochemicals: critical evaluation of potential aetiological factors of chronic kidney disease of multifactorial origin (CKDmfo/CKDu) and recommendations for its eradication.Environ Geochem Health. 2015; 38: 639-678Crossref PubMed Scopus (65) Google Scholar Most people with CKDu and MeN are poor, have minimal access to good health care and clean water, and are exposed to pollution and prolonged droughts.5Wimalawansa S.J. The role of ions, heavy metals, fluoride, and agrochemicals: critical evaluation of potential aetiological factors of chronic kidney disease of multifactorial origin (CKDmfo/CKDu) and recommendations for its eradication.Environ Geochem Health. 2015; 38: 639-678Crossref PubMed Scopus (65) Google Scholar Evidence suggests that CKDu is acquired following exposure to multiple factors: malnutrition, fluoride, pollution, effects of climate change, and unhealthy behavior; hence, the term CKD of multifactorial origin (CKDmfo).5Wimalawansa S.J. The role of ions, heavy metals, fluoride, and agrochemicals: critical evaluation of potential aetiological factors of chronic kidney disease of multifactorial origin (CKDmfo/CKDu) and recommendations for its eradication.Environ Geochem Health. 2015; 38: 639-678Crossref PubMed Scopus (65) Google Scholar, 7Wijkström J. Leiva R. Elinder C.G. et al.Clinical and pathological characterization of Mesoamerican nephropathy: a new kidney disease in Central America.Am J Kidney Dis. 2013; 62: 908-918Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar Until definitive causative factor(s) are identified, CKDu terminology should not be changed. The proposed names would stigmatize those affected and misdirect and delay research programs identifying specific causes and preventative efforts.