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Review
. 2017 Mar;2(2):282-292.
doi: 10.1016/j.ekir.2016.11.003.

Endemic Nephropathy Around the World

Fiona J Gifford  1 , Robert M Gifford  2 , Michael Eddleston  2 , Neeraj Dhaun  3
Affiliations
Review

Endemic Nephropathy Around the World

Fiona J Gifford et al. Kidney Int Rep. 2017 Mar.

Abstract

There have been several global epidemics of chronic kidney disease of unknown etiology (CKDu). Some, such as Itai-Itai disease in Japan and Balkan endemic nephropathy, have been explained, whereas the etiology of others remains unclear. In countries such as Sri Lanka, El Salvador, Nicaragua, and India, CKDu is a major public health problem and causes significant morbidity and mortality. Despite their geographical separation, however, there are striking similarities between these endemic nephropathies. Young male agricultural workers who perform strenuous labor in extreme conditions are the worst affected. Patients remain asymptomatic until end-stage renal failure. Biomarkers of tubular injury are raised, and kidney biopsy shows chronic interstitial nephritis with associated tubular atrophy. In many of these places access to dialysis and transplantation is limited, leaving few treatment options. In this review we briefly describe the major historic endemic nephropathies. We then summarize the epidemiology, clinical features, histology and clinical course of CKDu in Mesoamerica, Sri Lanka, India, Egypt, and Tunisia. We draw comparisons between the proposed etiologies and supporting research. Recognition of the similarities may reinforce the international drive to establish causality and to effect prevention.

Keywords: CKDu; chronic kidney disease; endemic nephropathy.

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Figures

Figure 1
Figure 1
World map indicating areas with high prevalence of chronic kidney disease of unknown etiology (CKDu). Central map taken from Wikipedia (https://commons.wikimedia.org/wiki/File:The_World_map.png). Peripheral maps modified from Google maps (Tunisia, https://www.google.co.uk/maps/place/Tunisia; Andhra Pradesh, https://www.google.co.uk/maps/place/Andhra+Pradesh; Sri Lanka, https://www.google.co.uk/maps/place/Sri+Lanka; Egypt, https://www.google.co.uk/maps/place/Egypt; Nicaragua/El Salvador, https://www.google.co.uk/maps/place/Nicaragua). NCP, North Central Province of Sri Lanka.
Figure 2
Figure 2
Multifactorial etiology of chronic kidney disease of unknown etiology (CKDu). ESRF, end-stage renal failure.
See this image and copyright information in PMC

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