scholarly journals Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka

2019 ◽  
Vol 14 (2) ◽  
pp. 224-232 ◽  
Author(s):  
Shuchi Anand ◽  
Maria E. Montez-Rath ◽  
Dinuka Adasooriya ◽  
Neelakanthi Ratnatunga ◽  
Neeraja Kambham ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Risk Ratio ◽  
Clinical Characteristics ◽  
Kidney Biopsy ◽  
Unknown Etiology ◽  
Sri Lankan ◽  
Urine Dipstick ◽  
A Prospective Study

Background and objectivesA kidney disease of unknown cause is common in Sri Lanka’s lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis.Design, setting, participants, & measurementsWe designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy.ResultsFrom 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics—age, urine dipstick for protein, and serum albumin—could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease.ConclusionsA primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.

scholarly journals Identification of Novel Rodent-Borne Orthohantaviruses in an Endemic Area of Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka

Viruses ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 1984
Author(s):  
Devinda S. Muthusinghe ◽  
Kenta Shimizu ◽  
Sithumini M. W. Lokupathirage ◽  
Zhouoxing Wei ◽  
Yomani D. Sarathkumara ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Sri Lanka ◽  
Kidney Disease ◽  
Small Mammals ◽  
Endemic Area ◽  
Phylogenetic Analyses ◽  
Rattus Rattus ◽  
Genetic Evidence ◽  
Unknown Etiology ◽  
Sri Lankan

We reported the genetic evidence of circulating hantaviruses from small mammals captured in a chronic kidney disease of unknown etiology (CKDu) hotspot area of Sri Lanka. The high seroprevalence of anti-hantavirus antibodies against Thailand orthohantavirus (THAIV) has been reported among CKDu patients and rodents in Sri Lankan CKDu hotspots. We captured 116 small mammals from CKDu endemic regions in the Polonnaruwa District of Sri Lanka. Seven animals (five out of 11 Mus booduga and two out of 99 Rattus rattus) were PCR-positive for the hantavirus. A rat-borne sequence was grouped with a THAIV-like Anjozorobe virus. In contrast, Mus-borne sequences belonged to the THAIV lineage, suggesting a novel orthohantavirus species according to the phylogenetic analyses and whole-genome comparisons. Our genetic evidence indicates the presence of two THAIV-related viruses circulating in this CKDu endemic area, suggesting a basis for further investigations to identify the infectious virus in patients with CKDu and the CKDu induction mechanism of these viruses.

Significance of Mg-hardness and fluoride in drinking water on chronic kidney disease of unknown etiology in Monaragala, Sri Lanka

2021 ◽  
pp. 111779
Author(s):  
D.N.D. Liyanage ◽  
Saranga Diyabalanage ◽  
S.P. Dunuweera ◽  
Sanath Rajapakse ◽  
R.M.G. Rajapakse ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Drinking Water ◽  
Sri Lanka ◽  
Kidney Disease ◽  
Unknown Etiology

Anthropometric changes in chronic kidney disease of unknown etiology (CKDU) patients: a single-center longitudinal study in Sri Lanka

2021 ◽  
Vol 46 ◽  
pp. S692
Author(s):  
H.M. Abeywickrama ◽  
Y. Koyama ◽  
S. Wimalasiri ◽  
M. Uchiyama ◽  
U. Shimizu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Longitudinal Study ◽  
Sri Lanka ◽  
Kidney Disease ◽  
Unknown Etiology ◽  
Single Center

scholarly journals MO638ANEMIA IN DIABETIC PATIENTS REFLECTS SEVERE TUBULOINTERSTITIAL INJURY AND ASSISTS CLINICALLY IN PREDICTING DIAGNOSIS OF DIABETIC NEPHROPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Soichiro Yokota ◽  
Kenji Ito ◽  
Maho Watanabe ◽  
Koji Takahashi ◽  
Naoko Himuro ◽  
...  
Keyword(s):  
Renal Function ◽  
Regression Analysis ◽  
Diabetic Nephropathy ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Kidney Biopsy ◽  
Renal Pathology ◽  
Diabetic Patients ◽  
Pathological Findings

Abstract Background and Aims Diabetic nephropathy (DN) is currently a leading cause of end-stage kidney disease worldwide. Kidney biopsy is generally performed in diabetic patients to discriminate between DN and non-diabetic kidney disease (NDKD), and to provide more specific treatments. In addition to conventional predicting factors of DN, recent studies suggested the predictive value of anemia in the diagnosis of DN, however detailed pathophysiology and the significance of anemia in renal pathology are not fully understood. This study aimed to investigate the impact of anemia on renal pathology and clinical course in patients who underwent kidney biopsy. Method We reviewed 81 patients (60.4 ± 13.7 years, 54 men and 27 women) with type 2 diabetes who underwent percutaneous kidney biopsy in Fukuoka University Hospital from January 2001 through March 2020. DN was diagnosed by mesangial expansion or nodular glomerulosclerosis observed under a light microscope, and immunofluorescence assisted in differentiating NDKD from DN. Anemia was defined as hemoglobin level <13 g/dL in males and <12 g/dL in females in accordance with the World Health Organization standards. Laboratory and pathological findings, and clinical courses were investigated. Results According to their pathological findings, patients were classified into two groups: isolated DN (DN group, n=30) and NDKD alone or concurrent DN (NDKD group, n=51). There were 11 types of NDKD. Of these, membranous nephropathy was the most common (23.5%), followed by IgA nephropathy (17.6%), and crescentic glomerulonephritis (13.7%). In multiple logistic regression analysis, absence of severe hematuria (odds ratio (OR) 11.66, 95% confidence interval (CI) 1.68 - 89.9) and presence of anemia (OR 11.38, 95% CI 2.51 - 51.52) were significantly related with the diagnosis of DN. Akaike’s information criterion (AIC) and net reclassification improvement (NRI) analyses revealed improved predictive performance by adding anemia to the conventional factors (AIC 100.152 to 91.844; NRI 27.0%). The tissues of patients in the DN group demonstrated more severe interstitial fibrosis and tubular atrophy (IF/TA) than the NDKD group (p<0.05) regardless of the rate of global glomerulosclerosis (figure), and IF/TA was related to the prevalence of anemia (odds ratio: 7.31, 95% confidence interval: 2.33 - 23.00) in multivariate regression analysis. These results suggest DM-associated severe IF/TA (compared with NDKD) impaired erythropoietin production, resulting in earlier anemia, independent of glomerular injuries and renal function. Furthermore, the renal prognosis was significantly better in the NDKD group than in the DN group using Log-rank test (p<0.05). Conclusion DN is associated with anemia because of severe IF/TA regardless of renal function, and anemia helps clinician discriminate clinically between isolated DN and NDKD.

scholarly journals Safe water for all: A nature-based approach for cyanotoxin elimination from potable water

2020 ◽  
Vol 2 (7A) ◽  
Author(s):  
Sylvia Soldatou ◽  
Anjali Jaykumar ◽  
Abeysiri H.A.S.N ◽  
Pathmalal M. Manage ◽  
Ondřej Mašek ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Kidney Disease ◽  
Crop Residues ◽  
Clean Energy ◽  
Cyanobacterial Blooms ◽  
Sri Lankan ◽  
High Concentration ◽  
Safe Water ◽  
Key Factor ◽  
Coconut Shells

Cyanobacterial blooms are a serious threat to public health and water quality due to the production of cyanotoxins as a result of nutrient pollution from industry, agriculture, domestic waste as well as global warming. The microcystins (MCs) are the most abundant cyanotoxins consisting of >200 analogues causing both acute and chronic toxicity, sometimes resulting in death. In Asian countries, such as Sri Lanka, reports of kidney disease are constantly increasing. Although no direct link between metal and pesticide contamination in water and kidney disease has been found, high concentration of cyanobacteria cells in drinking water wells implies that the nephrotoxic effects of cyanotoxins might play a key factor in the reports of Chronic Kidney Disease of unknown aetiology (CKDu) in Sri Lanka. Therefore, we propose a nature-based approach for water treatment which will study the hypotheses that cyanotoxins can cause CKDu. Sri Lankan bacterial isolates (Alcaligens sp., Roseateles sp., Bacillus sp., and Micrococcus sp.) known to degrade microcystins, were used to form biofilm on biochar from Sri Lankan crop residues, such as coconut shells. The immobilisation of the microbes was assessed via a high-throughput colourimetric assay, followed by monitoring the biodegradation rate of microcystins when added to the immobilised cultures. Biodegradation products were analysed and identified through molecular networking and quantified via LC-MS/MS. Ultimately, this project will provide safe water in line with UN Sustainable Development Goal 6.1 as well contributing in sustainable goals 7 (Affordable and Clean Energy), 11 (Sustainable Cities and Communities) and 12 (Responsible Production and Consumption).

Health-related Quality of Life among Patients with Chronic Kidney Disease of Unknown Etiology (CKDu) of an agricultural Community in Kebithigollawa, Sri Lanka

2021 ◽  
Author(s):  
Nishantha Kumarasinghe
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Sri Lanka ◽  
Kidney Disease ◽  
Unknown Etiology ◽  
Health Related Quality ◽  
Early Assessment ◽  
Related Quality ◽  
Health Related

Background: The significant increase in the burden of chronic kidney disease of unknown etiology (CKDu) of Sri Lanka has led to evaluate the factors related to physical, social and mental aspects of health-related quality of life (HRQOL) in CKDu patients. Methods: The quality of life of 84 CKDu patients (stages 1-5) were assessed by means of the Kidney Disease Quality of Life Short-Form survey (KDQOL™-36) Version 1.3 along with biomarkers and patient demographics. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Results: KDQOL™-36 scores impaired substantially across all stages of CKDu and comparatively lower scores were present in later stages of the disease than the initial stages. The mental composite summary (MCS) scores were more impaired when compared to physical composite summary (PCS) scores during the early stage of the disease. Poor KDQOL™-36 scores were present in males than in females with a significant difference in MCS and social support scales. Biochemical parameters showed a significant correlation with the majority of KDQOL™-36 dimensions while urine albumin to creatinine ratio did not. Conclusion: CKDu patients in any stage of the disease despite their age and gender have a significant physical and mental health burden. Thereby, early assessment of health-related quality of life will help to identify high-risk patients, and modifying these factors may provide a better active and healthy lifestyle.

scholarly journals Exposure to Hantavirus is a Risk Factor Associated with Kidney Diseases in Sri Lanka: A Cross Sectional Study

Viruses ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 700 ◽  
Author(s):  
Sarathkumara ◽  
Gamage ◽  
Lokupathirage ◽  
Muthusinghe ◽  
Nanayakkara ◽  
...  
Keyword(s):  
Risk Factor ◽  
Sri Lanka ◽  
Kidney Disease ◽  
Kidney Diseases ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Unknown Etiology ◽  
Hantavirus Infection ◽  
Sectional Study ◽  
Cross Sectional

Chronic kidney disease of unknown etiology (CKDu) imposes a substantial burden on public health in Sri Lankan agricultural communities. High seroprevalences of hantavirus have been reported in CKDu patients in several locations of Sri Lanka. We carried out a cross-sectional study followed by an unmatched case-control comparison in two geographically distinct areas of Sri Lanka, Girandurukotte (CKDu endemic) and Kandy (CKDu non-endemic) to determine whether exposure to hantaviruses is a potential risk factor in patients with kidney disease. An indirect immunofluorescent antibody assay using two antigens, Thailand orthohantavirus-infected and recombinant N protein-expressing Vero E6 cells, were used for serodiagnosis. Participants’ demographic and other socio-economic data were collected through a structured questionnaire. Fifty kidney disease patients and 270 controls from Kandy and 104 kidney disease patients and 242 controls from Girandurukotte were examined. Seropositivities were 50% and 17.4% in kidney patients and controls, respectively, in Girandurukotte, and they were 18% and 7% in Kandy. The odds of exposure to hantaviruses were higher for kidney disease patients than for controls in both Girandurukotte (OR:3.66, 95% CI:2.01 to 6.64) and Kandy (OR:2.64, 95% CI:1.07 to 6.54) in binary logistic regression models. According to statistical analysis, individuals exposed to hantaviruses had a higher risk of developing renal impairment. Therefore, hantavirus infection might be an important risk factor for development of kidney disease in Sri Lanka.

scholarly journals The Prognostic Value of Histopathologic Lesions in Native Kidney Biopsy Specimens: Results from the Boston Kidney Biopsy Cohort Study

2018 ◽  
Vol 29 (8) ◽  
pp. 2213-2224 ◽  
Author(s):  
Anand Srivastava ◽  
Ragnar Palsson ◽  
Arnaud D. Kaze ◽  
Margaret E. Chen ◽  
Polly Palacios ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Disease Progression ◽  
Kidney Biopsy ◽  
Hazard Ratio ◽  
Prognostic Information ◽  
Biopsy Specimens ◽  
Native Kidney ◽  
Kidney Disease Progression

Background Few studies have evaluated whether histopathologic lesions on kidney biopsy provide prognostic information beyond clinical and laboratory data.Methods We enrolled 676 individuals undergoing native kidney biopsy at three tertiary care hospitals into a prospective, observational cohort study. Biopsy specimens were adjudicated for semiquantitative scores in 13 categories of histopathology by two experienced renal pathologists. Proportional hazards models tested the association between histopathologic lesions and risk of kidney disease progression (≥40% eGFR decline or RRT).Results Mean baseline eGFR was 57.5±36.0 ml/min per 1.73 m2. During follow-up (median, 34.3 months), 199 individuals suffered kidney disease progression. After adjustment for demographics, clinicopathologic diagnosis, and laboratory values, the following lesions (hazard ratio; 95% confidence interval) were independently associated with progression: inflammation in nonfibrosed interstitium (0.52; 0.32 to 0.83), moderate and severe versus minimal interstitial fibrosis/tubular atrophy (2.14; 1.24 to 3.69 and 3.42; 1.99 to 5.87, respectively), moderate and severe versus minimal global glomerulosclerosis (2.17; 1.36 to 3.45 and 3.31; 2.04 to 5.38, respectively), moderate and severe versus minimal arterial sclerosis (1.78; 1.15 to 2.74 and 1.64; 1.04 to 2.60, respectively), and moderate and severe versus minimal arteriolar sclerosis (1.63; 1.08 to 2.46 and 2.33; 1.42 to 3.83, respectively). An 11-point chronicity score derived from semiquantitative assessments of chronic lesions independently associated with higher risk of kidney disease progression (hazard ratio per one-point increase, 1.19; 95% confidence interval, 1.12 to 1.27).Conclusions Across a diverse group of kidney diseases, histopathologic lesions on kidney biopsy provide prognostic information, even after adjustment for proteinuria and eGFR.

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