Aetiological factors of Chronic Kidney Disease in the North Central Province of Sri Lanka: A review of evidence to-date

Introduction Chronic kidney disease of unknown aetiology is a major health care problem in the North Central Province of Sri Lanka. During the last decade several researches were undertaken to identify the prevalence and aetiology of the disease. Fifteen manuscripts published in peer-reviewed scientific journals and two peer reviewed abstracts of were included in the review.

Results The disease mainly affects males from poor socio-economic backgrounds who are involved in paddy farming . Mild proteinuria was present but urinary sediments were normal. Renal biopsies were reported as interstitial nephritis. Significant predictors of kidney disease in these patients included age, history of smoking, being under treatment for hypertension and drinking well water in the fields. Studies on heavy metal and ochratoxin exposure have revealed conflicting results. Fluoride content of well water in all these areas exceeded the WHO recommended level of 0.6 mg/L. Water in all areas was alkaline which could facilitate mobilization of fluoride from minerals indicating a fluoride mediated mechanism for renal damage.

Conclusion The aetiology of CKDu in NCP of Sri Lanka is probably multi-factorial involving one or more environmental factors and a possible genetic predisposition in vulnerable populations.

DOI: http://dx.doi.org/10.4038/jccpsl.v17i1.4931

Journal of the College of Community Physicians of Sri Lanka Vol.17(2) June 2012 15-20