Abstract:
Chronic Kidney Disease of uncertain aetiology (CKDu) is an endemic disease among
agricultural workers in SriLanka. This study was designed to find the unique characteristics
of CKDu in Girandurukotte and Wilgamuwa. A detailed questionnaire survey was carried out
on life style and clinical history of biopsy proved non-dialysis CKDu patients (n=119) from
Girandurukotte and Wilgamuwa regional hospitals and healthy controls from the endemic
and non-endemic areas. Although nearly half of the patients (45.4%) were in advanced stages
of CKD (stage 3b or above), their mean blood pressure was normal. According to renal
function tests, 66.4% of CKDu patients had increased serum creatinine while 34.5% had
increased uric acid. As found in other CKD patients, alkaline phosphatase in serum was
higher, possibly due to bone diseases, while higher amylase may be due to reduced renal
excretion. These patients had no signs of systemic inflammation, based on C-reactive protein
(< 6 mg L
-1
) and low white cell count (7279 cells/mm3
). According to vitamin D and
hormone results, 62% CKDu patients had low levels of vitamin D (< 30 ng mL-1
) while other
hormones (TSH, PTH, Ferritin, Calcitonin, Aldosterone) were normal. According to the
osmolality findings, more than 50% of CKDu patients had increased serum osmolality while
63% had normal urine osmolality. The odds ratio indicated that family history of CKD,
chewing betel, malaria history, being a male and in the age group 40 – 60 years were
significant potential risk factors for CKDu in this area compared to controls. As noted in this
study, there were no apparent major differences between CKDu and CKD. Further,
evaluations of these findings will help proper patient management.
