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 (2012) 17:213221 DOI 10.1007/s12199-011-0243-9

REGULAR ARTICLE

Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka

Shanika Nanayakkara Toshiyuki Komiya Neelakanthi Ratnatunga

S. T. M. L. D. Senevirathna Kouji H. Harada Toshiaki Hitomi

Glenda Gobe Eri Muso Tilak Abeysekera Akio Koizumi

Received: 31 August 2011 / Accepted: 16 September 2011 / Published online: 13 October 2011 The Japanese Society for Hygiene 2011

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 Classication of Renal Allograft pathology. The correlations between the histological observations and clinical parameters were statistically analyzed. Interstitial brosis and tubular atrophy with or without nonspecic interstitial mononuclear cell inltration was the dominant histopathological observation. Glomerular sclerosis, glomerular collapse, and features of vascular pathology such as brous intimal thickening and arteriolar hyalinosis were also common. Although hypertension was identied as one of the common clinical features among the cases, it did not inuence 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.

Keywords Chronic kidney disease Farmers

Cadmium Histopathology Sri Lanka

Introduction

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. Those communities are mainly composed of immigrants

For the Chronic Kidney Disease of Uncertain Etiology Consortium.

S. Nanayakkara and T. Komiya contributed equally...