![]() Interstitial fibrosis, tubular atrophy with or without mononuclear cell infiltration in the interstitium have been identified as pathognomonic features of CKDu. īased on the results of a recent retrospective study carried out using 251 renal biopsies from patients in CKDu endemic areas of Sri Lanka, this is a tubulo-interstitial type disease condition. Similar to reports from Central America, Egypt and India, CKDu is prevalent among farming communities, and is particularly seen in the Anuradhapura and Polonnaruwa districts of the North Central Province (NCP), and the Badulla district in the Uva province of Sri Lanka, with a point prevalence of 15.1–22.9%. It is a slow progressive, irreversible disease condition and is asymptomatic until the last stage. The mean age of those affected by endemic CKDu in Sri Lanka was 37.3 ± 12.5 years, and the male to female ratio was 3.3:1. ![]() CKDu is diagnosed when Chronic Kidney Disease (CKD) is present without evidence of other possible causes such as diabetes, chronic or severe hypertension, snake bites, glomerulonephritis or urological diseases along with normal HbA1c levels (< 6.5%), blood pressure < 160/100 mmHg untreated, or < 140/90mm/Hg in those who are on up to two antihypertensive medications. Various toxic elements present in NCP water may contribute to different grade of kidney and liver lesions in Wistar rats.Ĭhronic Kidney Disease of unknown etiology (CKDu) is prevalent in Sri Lanka and is responsible for high morbidity and mortality in young adults in farming communities. Though Fluoride is a known kidney toxic agent it cannot be the sole reason for CKDu in NCP, Sri Lanka. All the water samples were negative for heavy metals. Compared to Colombo, high fluoride, calcium and sodium contents were observed in water from high disease prevalent areas. Association of Na +:Ca 2+ ratio in the disease progression was not reflected by the current study. Low disease prevalent area from NCP, Huruluwewa (HW) also reported elevated liver enzymes and altered renal histopathology. Rats that ingested boiled and un-boiled water from NTM also developed severe lesions whilst the group from Colombo reported the lowest. Rats that ingested water from high disease prevalent Divuldamana (DD) from NCP showed the highest kidney lesion index though the fluoride content was relatively low in this area compared to other water sources from high disease prevalent NCP. Histopathological findings after the 14 months experimental period revealed significantly high tubular lesion index in rats that ingested water from NCP compared to Colombo. Rats that ingested water from New Town Medirigiriya (NTM) from high disease prevalent NCP reported significantly elevated microalbumin:creatinine ratios compared to other water sources after 8 months, whilst boiled water from NTM had been able to significantly reduce it. Histopathology was analyzed using non-parametric method. Blood Urea Nitrogen, creatinine, urinary microalbumin:creatinine ratio together with ALT and AST levels were analyzed and results were compared using one-way ANOVA and paired t-Test. Rats were given water, collected from high and low disease prevalent areas from the NCP of Sri Lanka and the results compared with those obtained from previously identified low disease prevalent area Colombo. This in-vivo study was performed to investigate some of the suspected factors associated with the pathogenesis of CKDu mediated via ground water. ![]() Consumption of un-boiled dug well water has been identified as one of the causative factors. Chronic Kidney Disease of unknown etiology (CKDu) is prevalent in North Central Province (NCP) of Sri Lanka.
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