The Authors Reply

Abstract

We are happy that our paper1.Athuraliya N.T.C. Abeysekera T.D.J. Amerasinghe P.H. et al.Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka.Kidney Int. 2011; 80: 1212-1221Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar has generated interest among other scientists.2.Woo K.-T. Choong H.L. Tan H.B. et al.On uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka.Kidney Int. 2012; 81: 1277Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Certainly, the topic of chronic kidney disease with uncertain etiology (CKDu) is gaining wider attention in the region and worthy of looking at multiple factors that may be responsible. In the letter written by Woo et al.,2.Woo K.-T. Choong H.L. Tan H.B. et al.On uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka.Kidney Int. 2012; 81: 1277Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar paragraph 4 lacks clarity, in the light of the content given in paragraph 2. For instance, the 40% end-stage renal failure was in 1983 and not in the 1970s. Furthermore, we believe that the notion of mesangial proliferative glomerular nephritis of patients reported in the registry of 1983 is not well supported. The relevance of the reference3Nanayakkara S, Komiya T, Ratnatunga N et al. Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka. Environ Health Prev Med; 10.1007/s12199-011-0243-9.Google Scholar that refers to immunoglobulin (Ig)A nephropathy and membranoproliferative glomerular nephritis is not clear either. Although the hygiene hypothesis is indeed an interesting suggestion, the histopathology of kidneys of patients with CKDu in Sri Lanka indicates a tubulointerstitial disease with negative immunofluorescence for IgG, IgM, and complement 3 as described in the paper.1.Athuraliya N.T.C. Abeysekera T.D.J. Amerasinghe P.H. et al.Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka.Kidney Int. 2011; 80: 1212-1221Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar,3Nanayakkara S, Komiya T, Ratnatunga N et al. Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka. Environ Health Prev Med; 10.1007/s12199-011-0243-9.Google Scholar Therefore, we are more inclined to favor a toxic etiology given the current observations.