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. 2023 Oct;294(4):492-505.
doi: 10.1111/joim.13690. Epub 2023 Jul 9.

Clinical findings and kidney morphology in chronic kidney disease of unknown cause in India

Julia Wijkström  1 , Kumar Chakravarthy Annadata  2 , Carl-Gustaf Elinder  1 , Praveen Kumar Kolla  3 , Narayana Rao Sarvepalli  4 , Anneli Ring  5 , Rajendiran Swaminathan  6 , Barathi Gunabooshanam  6 , Magnus Söderberg  7 , Vidhya Venugopal  8 , Annika Wernerson  1
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Free article

Clinical findings and kidney morphology in chronic kidney disease of unknown cause in India

Julia Wijkström et al. J Intern Med. 2023 Oct.
Free article

Abstract

Background: Chronic kidney disease of unknown cause (CKDu) is an emerging health problem in India and other countries worldwide. However, clinical descriptions, including kidney pathology, are scarce.

Methods: This is a descriptive case series of patients with CKDu from an endemic region in India, with a focus on clinical and biochemical characteristics, kidney biopsy findings, and environmental exposure. Patients with suspected CKDu, aged 20-65, and eGFR 30-80 mL/min/1.73 m2 from rural areas with endemic prevalence of CKDu were included. The exclusion criteria were diabetes mellitus, uncontrolled hypertension, proteinuria >1 g/24 h, or other known kidney diseases. The participants underwent kidney biopsies, and blood and urine samples were collected.

Results: Fourteen participants (3 females, 11 males) with a mean eGFR of 53 (range 29-78) mL/min/1.73 m2 were included. Kidney biopsies showed a combination of chronic tubulointerstitial damage, glomerulosclerosis, and glomerular hypertrophy, with varying degrees of interstitial inflammation. Eight participants had polyuria (diuresis ≥ 3 L/day). The urinary sediments were bland, with no haematuria. Serum potassium and sodium levels were, in most cases, normal but within the lower reference interval.

Conclusion: The kidney morphology and clinical characteristics in patients with CKDu in India were similar to those described for CKDu in Central America and Sri Lanka.

Keywords: CKDu; India; chronic renal failure; kidney biopsy; pathology.

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References

    1. Johnson RJ, Wesseling C, Newman LS. Chronic kidney disease of unknown cause in agricultural communities. N Engl J Med. 2019;380:1843-52.
    1. Ganguli A. Uddanam nephropathy/regional nephropathy in India: preliminary findings and a plea for further research. Am J Kidney Dis. 2016;68:344-8.
    1. Tatapudi RR, Rentala S, Gullipalli P, Komarraju AL, Singh AK, Tatapudi VS, et al. High prevalence of CKD of unknown etiology in Uddanam, India. Kidney Int Rep. 2019;4:380-9.
    1. Farag YMK, Karai Subramanian K, Singh VA, Tatapudi RR, Singh AK. Occupational risk factors for chronic kidney disease in Andhra Pradesh: ‘Uddanam Nephropathy’. Ren Fail. 2020;42:1032-41.
    1. Parameswaran S, Rinu PK, Kar SS, Harichandrakumar KT, James TD, Priyamvada PSP, et al. A newly recognized endemic region of CKD of undetermined etiology (CKDu) in South India-“Tondaimandalam Nephropathy”. Kidney Int. 2020;5:2066-73.

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