Abstract
Chronic kidney disease of uncertain etiology (CKDu) in North Central Province of Sri Lanka has become a key public health concern in the agricultural sector due to the dramatic rise in its prevalence and mortality among young farmers. Although cadmium has been suspected as a causative pathogen, there have been controversies. To date, the pathological characteristics of the disease have not been reported. Histopathological observations of 64 renal biopsies obtained at Anuradhapura General Hospital from October 2008 to July 2009 were scored according to Banff 97 Working Classification of Renal Allograft pathology. The correlations between the histological observations and clinical parameters were statistically analyzed. Interstitial fibrosis and tubular atrophy with or without nonspecific interstitial mononuclear cell infiltration was the dominant histopathological observation. Glomerular sclerosis, glomerular collapse, and features of vascular pathology such as fibrous intimal thickening and arteriolar hyalinosis were also common. Although hypertension was identified as one of the common clinical features among the cases, it did not influence the histopathological lesions in all the cases. This study concludes that tubulointerstitial damage is the major pathological lesion in CKDu. Exposure(s) to an environmental pathogen(s) should be systematically investigated to elucidate such tubulointerstitial damage in CKDu.
Highlights
Chronic kidney disease (CKD) is an emerging public health problem globally because of its increasing prevalence and its associated adverse clinical outcomes, poor quality of life, and high healthcare costs [1, 2]
During the past two decades, an endemic condition of CKD has become prevalent among the low-socioeconomic farming community in the North Central Province (NCP) of Sri Lanka, which is the main agricultural region in the country
To evaluate the possibility of renal pathological lesions to predict Chronic kidney disease of uncertain etiology (CKDu) severity and to determine the clinical and demographic factors which can influence the severity of the disease, we assessed the correlation between each lesion with age, presence of hypertension, serum creatinine, and GFR
Summary
Chronic kidney disease (CKD) is an emerging public health problem globally because of its increasing prevalence and its associated adverse clinical outcomes, poor quality of life, and high healthcare costs [1, 2]. Quantitative criteria for vascular fibrous intimal thickening and for arteriolar hyaline thickening in the Banff classification were used to assess the type and severity of small artery and arteriolar pathological lesions in specimens within which blood vessels could be observed (N = 53)[12]. To evaluate the possibility of renal pathological lesions to predict CKDu severity and to determine the clinical and demographic factors which can influence the severity of the disease, we assessed the correlation between each lesion with age, presence of hypertension, serum creatinine, and GFR.
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