Is the staple diet eaten in Medawachchiya, Sri Lanka, a predisposing factor in the development of chronic kidney disease of unknown etiology? - A comparison based on urinary β2-microglobulin measurements.

Ea Ranga Ie Siriwardhana,Kosala Gad Weerakoon,Thilak Abeysekara,Ramiah Sivakanesan,Ponnumperuma Aj Perera,Danaseela B Nugegoda

doi:10.1186/1471-2369-15-103

Ea Ranga Ie Siriwardhana, Kosala Gad Weerakoon + Show 4 more

Open Access

https://doi.org/10.1186/1471-2369-15-103

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Abstract

BackgroundExact mechanism of causation of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is not described to date, despite the identification of possible multiple risk factors. Questions have been raised as to why only some are affected while others remain intact, though they are inhabitants of the same locality.MethodsComparative studies were carried out, assessing urinary β2 microglobulin (β2m) and the dietary patterns of CKDu patients and age sex matched non-CKDu subjects. Urinary β2m levels of spot urine samples were analyzed using the Enzyme-linked Immunosorbent assay (ELISA) and dietary patterns were studied using twenty four hour dietary recalls and frequency consumption of foods of animal origin performed on three occasions at six months intervals within a period of one and half years.ResultsThe mean urinary β2m level of CKDu patients from Medawachchiya was significantly (p < 0.05) higher when compared with that of the non-CKDu subjects. The mean urinary β2m level of the non-CKDu subjects was within the reference limits for spot urine samples (0 – 0.3 μg/mL). White raw rice was the staple diet of both CKDu patients and non-CKDu subjects and the level of consumption was almost the same. The consumption of fresh water fish products of CKDu patients under high (14, 14%), moderate (36, 36%), low (26, 26%) and less (20, 20%) categories did not show significant variations (p > 0.05) compared to non-CKDu subjects.ConclusionsStaple food in diet and the consumption pattern of CKDu patients from Medawachchiya were similar to that of non-CKDu subjects from the same area despite their urinary β2m concentration being significantly higher.

Highlights

Exact mechanism of causation of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is not described to date, despite the identification of possible multiple risk factors
The mean urinary β2m level of the non-CKDu subjects was within the reference limits for spot urine samples (0–0.3 μg/mL)
The mean urinary β2m levels of CKDu patients gradually increased with the degree of deterioration of kidney function (Table 2)

Summary

Introduction

Exact mechanism of causation of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is not described to date, despite the identification of possible multiple risk factors. Chronic kidney disease of unknown aetiology (CKDu) has been reported in developing countries including Nicaragua, countries of Balkan region, Tunisia and Sri Lanka [1,2,3]. CKDu has been reported from certain parts of Sri Lanka, including the North Central, North Western and Uva. Numerous studies of diverse disciplines have been carried out to reveal the credible contributory factors for the disease. Current research conducted on CKDu in Sri Lanka suggests heavy metals as the major aetiological factor and food chains as the possible route of heavy metal entry into the bodies of those afflicted by the disease [5,7]. Main objectives of the current study were to compare the variation in urinary β2m excretion of CKDu patients and non-CKDu subjects, inhabiting in a CKDu endemic area, and to compare the dietary patterns of CKDu patients and non-CKDu subjects from the same area

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