Abstract
CKDu has been identified as a major public health issue in countries such as Sri Lanka, India and Nicaragua, which causes significant deaths per year. Significant similarities have been observed among these endemic nephropathies regardless of their geographical separation. Existing evidence favors a multi-factorial etiology, but research over the last few decades has failed to recognize the specific risk factors. Based on the geographical distribution that is unique and evidence of histopathological nature, it is speculated that CKDu is environmentally induced health problem. Hypothesis linking acetylcholinesterase (AChE) inhibiting organophosphate pesticides, metal-chelating glyophosate, agrochemicals, cadmium, arsenic, fluoride, hardness, and algae/cyanobacteria are considered as important factors in the etiology of CKDu. However, to date, no single geochemical parameter is shown to be directly related to the CKD etiology on the basis of the elements determined during research studies, and it is very likely that the unique hydrogeochemistry and microbiology of the drinking water is closely associated with the incidence of the disease in the endemic areas. The paper discuss understudied area of research is whether cyanotoxin formation from algal blooms may be a risk factor that contributes to CKDu in Sri Lanka as cyanotoxins in CKDu has been considered but not investigated.
Highlights
Chronic Kidney Disease (CKD) is a global health problem and it identified as the 7th most common cause of death according to World Health Organization (WHO) (2012)
The number of patients with CKD unknown etiology (CKDu) in Sri Lanka have increased alarmingly over recent decades in the dry zone of rural farming communities leading to national concern and urgent need for action as Chronic Kidney Disease of unknown etiology (CKDu) is a leading non-communicable disease, and cause of death (Eckardt et al 2009)
A WHO study showed significantly higher urinary excretion of cadmium in individuals with CKDu, and the dose–effect relationship between urine cadmium concentration and CKDu stages (Jayatilake et al 2013). These findings suggest that cadmium exposure is a risk factor for the pathogensis of CKDu
Summary
Chronic Kidney Disease (CKD) is a global health problem and it identified as the 7th most common cause of death according to WHO (2012). The number of patients with CKD unknown etiology (CKDu) in Sri Lanka have increased alarmingly over recent decades in the dry zone of rural farming communities leading to national concern and urgent need for action as CKDu is a leading non-communicable disease, and cause of death (Eckardt et al 2009). Existing evidence favors a multi-factorial etiology, but research over the last few decades has failed to recognize the specific risk factors. In research conducted to date, significant effort has been made to characterize CKDu in each of the endemic areas independently and through developing regionspecific hypotheses for the root causes using selected geographies. Causative factors and etiology of this chronic kidney disease is still considered uncertain or unknown and abbreviated as Chronic Kidney Disease of unknown etiology (CKDu)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
