Abstract
Chronic kidney disease of unknown etiology (CKDu) imposes a substantial burden on public health in Sri Lankan agricultural communities. High seroprevalences of hantavirus have been reported in CKDu patients in several locations of Sri Lanka. We carried out a cross-sectional study followed by an unmatched case-control comparison in two geographically distinct areas of Sri Lanka, Girandurukotte (CKDu endemic) and Kandy (CKDu non-endemic) to determine whether exposure to hantaviruses is a potential risk factor in patients with kidney disease. An indirect immunofluorescent antibody assay using two antigens, Thailand orthohantavirus-infected and recombinant N protein-expressing Vero E6 cells, were used for serodiagnosis. Participants’ demographic and other socio-economic data were collected through a structured questionnaire. Fifty kidney disease patients and 270 controls from Kandy and 104 kidney disease patients and 242 controls from Girandurukotte were examined. Seropositivities were 50% and 17.4% in kidney patients and controls, respectively, in Girandurukotte, and they were 18% and 7% in Kandy. The odds of exposure to hantaviruses were higher for kidney disease patients than for controls in both Girandurukotte (OR:3.66, 95% CI:2.01 to 6.64) and Kandy (OR:2.64, 95% CI:1.07 to 6.54) in binary logistic regression models. According to statistical analysis, individuals exposed to hantaviruses had a higher risk of developing renal impairment. Therefore, hantavirus infection might be an important risk factor for development of kidney disease in Sri Lanka.
Highlights
Chronic kidney disease (CKD) is a major global public health problem [1]
A severe form of CKD that has been reported in individuals without any association of these known risk factors is defined as CKD of unknown etiology (CKDu) [2]
RNP was observed as a defused pattern in the cytoplasm by anti-NP monoclonal antibody and no fluorescence pattern was observed by anti-GP monoclonal antibody in Recombinant N protein (rNP)-based antigen
Summary
Chronic kidney disease (CKD) is a major global public health problem [1]. Diabetes mellitus and hypertension are the most common causes of CKD in developed countries. A severe form of CKD that has been reported in individuals without any association of these known risk factors is defined as CKD of unknown etiology (CKDu) [2]. CKDu has emerged as a significant public health crisis in rural agricultural communities in Sri Lanka, among sugarcane farmers in Central American countries, and in some areas of India and Egypt [3]. In Sri Lanka, the number of CKDu patients has been increasing rapidly since the 1990s, mainly in the dry zones of North-Central, Uva and North. CKDu prevalence ranges from 15.1% to 22.9% in highly prevalent areas [4]
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