Format

Send to

Choose Destination
Clin J Am Soc Nephrol. 2019 Jan 18. pii: CJN.07430618. doi: 10.2215/CJN.07430618. [Epub ahead of print]

Prospective Biopsy-Based Study of Chronic Kidney Disease of Unknown Etiology in Sri Lanka.

Author information

1
Division of Nephrology and Departments of Sanand2@stanford.edu.
2
Division of Nephrology and Departments of.
3
Kandy Teaching Hospital, Kandy, Sri Lanka.
4
Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and.
5
Department of Pathology, University of Peradeniya, Kandy, Sri Lanka.
6
Pathology.
7
Department of Community Medicine and Health Care and.
8
Department of Marine Sciences, University of Connecticut, Groton, Connecticut; and.
9
Division of Nephrology, University of Connecticut Health Center, Farmington, Connecticut.
10
Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
11
Pediatrics, and.
12
Medicine, Stanford University School of Medicine, Palo Alto, California.

Abstract

BACKGROUND AND OBJECTIVES:

A kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

We designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy.

RESULTS:

From 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics-age, urine dipstick for protein, and serum albumin-could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease.

CONCLUSIONS:

A primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.

PODCAST:

This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_01_18_CJASNPodcast_19_02_.mp3.

KEYWORDS:

Biopsy; Consensus; Farmers; Life Style; Logistic Models; Nephritis, Interstitial; Prospective Studies; Renal Insufficiency, Chronic; Serum Albumin; Sri Lanka; Tobacco; diabetes mellitus; hypertension; kidney; nephrology; risk factors

PMID:
30659059
DOI:
10.2215/CJN.07430618

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center