Abstract
BackgroundHigh water hardness associated with high water fluoride and the geographical distribution of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka are well correlated. We undertook this study to observe the effects of high water hardness with high fluoride on kidney and liver in rats and efficacy of distilled water in reducing the effects.MethodsTest water sample with high water hardness and high fluoride was collected from Mihinthale region and normal water samples were collected from Kandy region. Twenty-four rats were randomly divided into 8 groups and water samples were introduced as follows as daily water supply. Four groups received normal water for 60 (N1) and 90 (N2) days and test water for 60 (T1) and 90 (T2) days. Other four groups received normal (N3) and test (T3) water for 60 days and followed by distilled water for additional 60 days and normal (N4) and test (T4) water for 90 days followed by distilled water for another 90 days. The rats were sacrificed following treatment. Serum samples were subjected to biochemical tests; serum creatinine, urea, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and elemental analysis. Histopathological examinations were carried out using kidney and liver samples.ResultsTest water treated groups were associated with acute tubular injury with loss of brush border and test water followed with distilled water treated groups maintained a better morphology with minimal loss of brush border. Serum creatinine levels in T1 and T2 groups and urea level in T2 group were significantly (p < 0.05) increased compared to control groups. After administration of distilled water, both parameters were significantly reduced in T4 group (p < 0.05) compared to T2. Serum AST activity was increased in T4 group (p < 0.05) compared to control group with no histopathological changes in liver tissues. The serum sodium levels were found to be much higher compared to the other electrolytes in test groups.ConclusionHard water with high fluoride content resulted in acute tubular injury with a significant increase in serum levels of creatinine, urea and AST activity. These alterations were minimized by administering distilled water.
Highlights
High water hardness associated with high water fluoride and the geographical distribution of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka are well correlated
Hard water with high fluoride content resulted in acute tubular injury with a significant increase in serum levels of creatinine, urea and Aspartate aminotransferase (AST) activity
Water samples: A water sample with high fluoride and high hardness was collected in June 2017 from a selected dug well in Mihinthale area, a region located in North Central Province of Sri Lanka (8 20′ 57′′N 80 30′ 03′′E) as a test water sample based on the regional water quality information gathered from the Department of Geology, University of Peradeniya, Sri Lanka
Summary
High water hardness associated with high water fluoride and the geographical distribution of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka are well correlated. There has been a rising incidence and prevalence of chronic renal failures that has emerged in the North Central region (NCR) of Sri Lanka where the disease is not associated with any known risk factors [2]. The elevated levels of fluoride, which is defined as above 0.5 mg/L by the World Health Organization in groundwater sources is observed in CKDu endemic regions [6]. Fluoride has received increased attention as a risk factor in the etiology of CKDu [7, 8]. The hydrogeochemical investigations in CKDu endemic areas revealed that both fluoride and hardness is elevated in all CKDu endemic regions [12]
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