Abstract
To study the early pathological changes in renal lesions of asymptomatic patients with kidney diseases, with no definite aetiology living in regions endemic for chronic kidney disease of unknown etiology (CKDUe). Design Retrospective study. Regions endemic for CKDUe in and around the North Central Province of Sri Lanka. Two hundred and eleven asymptomatic patients living in endemic regions detected with renal disease by screening for proteinuria using the dipstick method. Those with long standing hypertension, diabetes mellitus, histological diagnosis of primary glomerular diseases, immunocomplex mediated diseases or renal lesions secondary to systemic diseases were excluded. Renal lesions were divided into seven histological categories depending on the pathological changes: Category 0: no detectable changes. Category 1: Interstitial fibrosis ± mild interstitial inflammation ± tubular atrophy; no glomerulosclerosis. Category 2: Interstitial fibrosis ± mild interstitial inflammation ± tubular atrophy; glomerulosclerosis. Category 3: Moderate or severe interstitial fibrosis, interstitial inflammation and tubular atrophy ± glomerulosclerosis; Category 4: Interstitial inflammation ± tubular atrophy ± glomerulosclerosis; no interstitial fibrosis. Category 5: The prominent change is interstitial inflammation with tubulitis. Category 6: Severely scarred kidney. Histological categories were compared with calculated glomerular filtration rates and age of the patients. Number of cases in histological categories 0 to 6 were: 7 (3.3%), 71 (33.6%), 53 (25.1%), 63 (29.9%), 0, 2 (0.9%) and 15 (7.1%) respectively. The mean glomerular filtration rate was >90 ml/min in patients in category 0 and 1 and declined progressively in categories 2 and 3. Apart from category 0, all had interstitial fibrosis and in category 1, 62 (87.3%) had interstitial fibrosis without inflammation. Severity of interstitial inflammation increased from category 1 to 3. The early disease among asymptomatic patients is characterized by interstitial fibrosis without significant interstitial inflammation and glomerular sclerosis with preserved glomerular function. Although the role of interstitial inflammation in the initiation of the disease is not clear, it appears to have a role in the progression of the disease.
Highlights
Chronic kidney disease of unknown aetiology (CKDU) is endemic among several rural farming communities in and around the North Central Province (NCP) of Sri Lanka, namely, Medawachchiya, Padaviya, Siripura, Horowpathana, Medirigiriya, Polonnaruwa, Nikawewa, Dehiattakandiya and Girandurukotte [1-4]
The early disease among asymptomatic patients is characterized by interstitial fibrosis without significant interstitial inflammation and glomerular sclerosis with preserved glomerular function
The role of interstitial inflammation in the initiation of the disease is not clear, it appears to have a role in the progression of the disease
Summary
Chronic kidney disease of unknown aetiology (CKDU) is endemic among several rural farming communities in and around the North Central Province (NCP) of Sri Lanka, namely, Medawachchiya, Padaviya, Siripura, Horowpathana, Medirigiriya, Polonnaruwa, Nikawewa, Dehiattakandiya and Girandurukotte [1-4]. Studies have been carried out to determine the aetiology of this disease a definite aetiological agent has not been identified yet. Clustering of the disease around water reservoirs has been observed [3]. The common known causes of chronic kidney disease such as diabetes and essential hypertension are unlikely causes [2, 6]. The cause is unlikely to be Ochrotoxin A, previously implicated in Balkan endemic nephropathy [7]. Some of the implicated aetiological factors that are under investigation include heavy metals, high ground water fluoride and agrochemicals [8-11]
Sign-in/Register to view highlights & summary 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
