Abstract:
Chronic Kidney Disease of uncertain etiology (CKDu) is a recently described tubular
interstitial nephropathy in some tropical countries including SriLanka. The major limitation
of the traditional markers is missing the early disease. The aim of this study was to identify
the importance of the serum Transforming Growth Factor 1(TGF beta1) as an early marker
for CKDu in SriLanka. In the case group, 76 of definite, non-dialysis CKDu patients were
recruited. For control groups, endemic control (EC 79), endemic CKD (ECKD 79), non endemic control (NEC 85) and non-endemic CKD (NECKD 85) were recruited. Serum
TGF beta 1 was measured in a Luminex MAGPIX platform. The higher mean value of
TGF beta1 (69587 pg/mL) was obtained from the CKDu group compared to other control
groups. There was a significant difference in mean TGF beta1 of CKDu with other four
control groups (p< 0.001). A significant difference was seen in CKDu group between stage
2 and 4, 3a and 4 and 3b and 4. In CKDu and NECKD group, there was a negative
correlation with serum creatinine (r= -0.293 & -0.247) and positive correlation (r= 0.332 &
0.242) with the eGFR which were significant (p< 0.01). According to the ROC analysis, to
differentiate CKDu from the other endemic and non-endemic CKD forms TGF beta1
showed a good AUC than the serum creatinine (0.955 & 0.987 respectively). For healthy
control groups, TGF beta1 showed a slightly decreased value of AUC than the serum
creatinine (0.862 & 0.902). The negative correlation of TGFbeta1 with the serum
creatinine also supports the feature of early detection of the CKDu. Our results suggest that
serum TGF beta1 could be a marker of early detection of CKDu and useful to differentiate
CKDu from other CKD types.
