Chronic Kidney Disease of Unknown Etiology in Telangana: Is It Different?

Abstract

Background Chronic kidney disease of unknown etiology (CKDu) is emerging as an important cause for CKD in various parts of the world, including India. This study was done to determine the risk factors and histology of CKDu in Telangana, a neighboring state of Andhra Pradesh that has CKDu hotspots. Materials and Methods This prospective observational study was done from March 2021 to November 2022 at a tertiary care center in Hyderabad. Patients were included as per the Indian CKDu definition. Sociodemographic data, examination, and investigations were obtained. Drinking water was analyzed. Patients with preserved kidney sizes underwent kidney biopsy. Patients were followed up with estimated glomerular filtration rate (eGFR) at 0.6 months and one year. Results A total of 75 patients were studied. Mean age was 41.72 +/- 13.59 years, where 68% were males. Groundwater was the drinking water source for 77.3%. In all, 40% had consumed alternate medicine and 46.6% patients had undergone kidney biopsy. The main findings were global glomerulosclerosis (>50%) in 54%, 31% had >50% interstitial fibrosis and tubular atrophy, 34.3% had periglomerular fibrosis, and 85.7% had interstitial inflammation. Hypertension was a significant risk factor for progression. Conclusion Our study results were like other Indian studies in terms of affecting younger male population, but differed from these studies as the majority of our patients came from nonagricultural backgrounds. Herbal medicine intake was a major risk factor. A vast majority of patients had chronic tubulointerstitial nephritis in biopsy at presentation, showing that most presented late.