Abstract
BackgroundSri Lankan Agricultural Nephropathy (SAN), a new form of chronic kidney disease among paddy farmers was first reported in 1994. It has now become the most debilitating public health issue in the dry zone of Sri Lanka. Previous studies showed SAN is a tubulo-interstitial type nephropathy and exposure to arsenic and cadmium may play a role in pathogenesis of the disease.MethodsUrine samples of patients with SAN (N = 10) from Padavi-Sripura, a disease endemic area, and from two sets of controls, one from healthy participants (N = 10) from the same endemic area and the other from a non-endemic area (N = 10; Colombo district) were analyzed for 19 heavy metals and for the presence of the pesticide- glyphosate.ResultsIn both cases and the controls who live in the endemic region, median concentrations of urinary Sb, As, Cd, Co, Pb, Mn, Ni, Ti and V exceed the reference range. With the exception of Mo in patients and Al, Cu, Mo, Se, Ti and Zn in endemic controls, creatinine adjusted values of urinary heavy metals and glyphosate were significantly higher when compared to non-endemic controls. Creatinine unadjusted values were significant higher for 14 of the 20 chemicals studied in endemic controls and 7 in patients, compared to non-endemic controls. The highest urinary glyphosate concentration was recorded in SAN patients (range 61.0-195.1 μg/g creatinine).ConclusionsPeople in disease endemic area exposed to multiple heavy metals and glyphosate. Results are supportive of toxicological origin of SAN that is confined to specific geographical areas. Although we could not localize a single nephrotoxin as the culprit for SAN, multiple heavy metals and glyphosates may play a role in the pathogenesis. Heavy metals excessively present in the urine samples of patients with SAN are capable of causing damage to kidneys. Synergistic effects of multiple heavy metals and agrochemicals may be nephrotoxic.
Highlights
Sri Lankan Agricultural Nephropathy (SAN), a new form of chronic kidney disease among paddy farmers was first reported in 1994
It has been shown that continuous exposure, as detected by low concentrations of urinary heavy metal levels is associated with an increased oxidative Deoxyribo Nucleic Acid (DNA) damage and impaired DNA repair in adolescents [5]
Except for Ba, Mo, Sn, and Ti creatinine unadjusted median value of all other heavy metals and glyphosate in the urine is higher in patients and endemic controls when compared to the controls in the nonendemic area
Summary
Sri Lankan Agricultural Nephropathy (SAN), a new form of chronic kidney disease among paddy farmers was first reported in 1994. It has become the most debilitating public health issue in the dry zone of Sri Lanka. Heavy metals are natural components of the earth’s crust. These elements are the oldest toxins known to humans, having been used for thousands of years. Potential sources of heavy metal exposure include natural sources, industrial processes, commercial products, folk remedies, contaminated food and herbal products [1]. Among the heavy metals having the most serious health implications are arsenic, lead, cadmium, and mercury [4]. It has been shown that continuous exposure, as detected by low concentrations of urinary heavy metal levels is associated with an increased oxidative DNA damage and impaired DNA repair in adolescents [5]
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