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Abstract Background Chronic kidney disease (CKD) is a significant clinical challenge in Sri Lanka. The present study presents histopathological diagnoses from native renal biopsies in Kandy District, 2011–2020. Methods Reports of 5,014 renal biopsies principally performed at Kandy Teaching Hospital over 2011–2020 were reviewed. After exclusions for post-kidney transplant biopsies (1,572) and those without evident pathology (347), 3,095 biopsies were included. The predominant histopathological entities were grouped and categorised according to diagnosis and stratified by age and sex. Results The main histopathological entities (all biopsies) were tubulointerstitial nephropathy (TIN) 25% (n = 760), glomerulonephritis (GN) 15% (467), lupus nephropathy 14% (429), focal segmental glomerular sclerosis (FSGS) 10% (297), and IgA nephropathy (IgAN) 8% (242). For adult women ≥ 15 years, the main histopathological entities were lupus nephropathy 24% (325), TIN 17% (228), and GN 16% (217). For adult men ≥ 15 years, the main histopathological entities were TIN 34% (449), GN 14% (180), and IgAN 10% (125). The proportion of TIN in the present study was higher than international studies of a similar size. Conclusion This is the largest study of renal biopsies reported from Sri Lanka to date. TIN was the most common diagnosis in adults ≥ 15 years at 25%. Notable sex differences showed TIN was the most common histopathology in men (34%) but not in women (17%). No previously published similar study of this size has found TIN as the predominant diagnosis amongst renal biopsies in men. Further research is required into the possible causes of these observations in Sri Lanka. Clinical Trial Number. Not applicable.

Background: Chronic kidney disease (CKD) is a significant clinical challenge in Sri Lanka. The present study presents histopathological diagnoses from native renal biopsies in Kandy District, 2011–2020. Methods: Reports of 5,014 renal biopsies principally performed at Kandy Teaching Hospital over 2011–2020 were reviewed. After exclusions for post-kidney transplant biopsies (1,572) and those without evident pathology (347), 3,095 biopsies were included. The predominant histopathological entities were grouped and categorised according to diagnosis and stratified by age and sex. Results: The main histopathological entities (all biopsies) were tubulointerstitial nephropathy (TIN) 25% (n = 760), glomerulonephritis (GN) 15% (467), lupus nephropathy 14% (429), focal segmental glomerular sclerosis (FSGS) 10% (297), and IgA nephropathy (IgAN) 8% (242). For adult women ≥ 15 years, the main histopathological entities were lupus nephropathy 24% (325), TIN 17% (228), and GN 16% (217). For adult men ≥ 15 years, the main histopathological entities were TIN 34% (449), GN 14% (180), and IgAN 10% (125). The proportion of TIN in the present study was higher than international studies of a similar size. Conclusion: This is the largest study of renal biopsies reported from Sri Lanka to date. TIN was the most common diagnosis in adults ≥ 15 years at 25%. Notable sex differences showed TIN was the most common histopathology in men (34%) but not in women (17%). No previously published similar study of this size has found TIN as the predominant diagnosis amongst renal biopsies in men. Further research is required into the possible causes of these observations in Sri Lanka. Clinical Trial Number. Not applicable. [ABSTRACT FROM AUTHOR]

During the last two decades, an epidemic of a severe form of chronic kidney disease (CKD) unrelated to traditional risk factors (diabetes and hypertension) has been recognized in low‐ to middle‐income countries. CKD of unknown aetiology (CKDu) mainly affects young working‐age adults, and has become as an important and devastating public health issue. CKDu is a multifactorial disease with associated genetic and environmental risk factors. This review summarizes the current epidemiological evidence on the burden of CKDu and its probable environmental risk factors contributing to CKD in Africa. PubMed/Medline and the African Journals Online databases were searched to identify relevant population‐based studies published in the last two decades. In the general population, the burden of CKD attributable to CKDu varied from 19.4% to 79%. Epidemiologic studies have established that environmental factors, including genetics, infectious agents, rural residence, low socioeconomic status, malnutrition, agricultural practise and exposure to agrochemicals, heavy metals, use of traditional herbs, and contaminated water sources or food contribute to the burden of CKD in the region. There is a great need for epidemiological studies exploring the true burden of CKDu and unique geographical distribution, and the role of environmental factors in the development of CKD/CKDu. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) of unknown aetiology is a form of tubulointerstitial CKD in the absence of traditional and known predisposing risk factors. Since the early 2000s, there is an emerging trend in marginalised agricultural communities among workers exposed to occupational and environmental hazards. CKD of unknown aetiology has received significant attention in recent years and is becoming increasingly relevant to the Australian medical community with the growing migrant population, which this case‐based communication illustrates. [ABSTRACT FROM AUTHOR]

Background We aimed to determine the prevalence of decreased kidney function in a potential chronic kidney disease (KD) of unknown aetiology hotspot in Mexico, assess its distribution across occupations and examine the associated risk factors. Methods A cross-sectional study collected sociodemographic, occupational, medical and biometric data from 616 men and women aged 20–60 years who were residents of three communities within the Tierra Blanca region in Mexico. Kidney function was assessed by standardized serum creatinine and estimated glomerular filtration rate (eGFR) and semi-quantitative albumin-to-creatinine ratio (ACR). To examine the distribution of decreased kidney function within the population, age- and sex-adjusted prevalence of low eGFR (≤60 mL/min/1.73 m2) was estimated for all participants and across occupations. Multivariable logistic regression was used to assess the association of occupation with having low eGFR. Results Of the 579 participants analysed (37 excluded due to missing data), the age- and sex-adjusted prevalence of low eGFR was 3.5%. Agriculture was the occupation associated with the highest adjusted prevalence of low eGFR (8.8%), with 1 in every 11 agricultural workers having low eGFR. Working in agriculture was independently associated with more than a 5-fold risk of having low eGFR [odds ratio 5.2 (95% confidence interval 1.1–24.3), P = 0.032], after adjustment for age, sex, diabetes, hypertension, body mass index, ACR and family history of KD. Additionally, a quarter of the population (25%) had either low eGFR or an ACR >30 mg/g, mostly due to albuminuria. Conclusions Our work suggests that there is a high prevalence of decreased kidney function in Tierra Blanca, particularly amongst agricultural workers. [ABSTRACT FROM AUTHOR]

Abstract Background After two-years of follow-up of 263 apparently healthy 18- to 30-year-old men in communities affected by Mesoamerican nephropathy (MeN), we identified three distinct case groups: a subgroup with (i) established renal dysfunction (case-group 1); individuals with (ii) a rapid decline in kidney function (case-group 2); and individuals with (iii) stable kidney function (non-cases). This paper investigates whether local tests are potentially useful for the timely identification of these case groups. Methods Creatinine levels were measured in local laboratories every six months for two years. Aliquots were sent to a centralized laboratory for measurements of cystatin C and creatinine levels. We investigated agreement between the locally and centrally measured creatinine-based Chronic Kidney disease Epidemiology Collaboration (CKD-EPI) equation for estimating the Glomerular Filtration Rate (eGFR). A logistic regression analysis was used to assess predictive factors for case groups 1 and 2 compared to non-cases. Predictive variables were locally measured eGFR, and urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels. The discrimination performance of the model was assessed using the area under the receiver operating characteristic curve (AUC). Results Considerable variation in local eGFR measurements was observed. The prediction model for case-group 1 included baseline kidney function and with or without uNGAL (AUC = 0.98, 95% confidence interval (CI), 0.91–1.00). The prediction model for case-group 2 also required eGFRScr at six and twelve months after baseline, with or without uNGAL levels (AUC = 0.88; 95% CI 0.80–0.99). Conclusions Established renal dysfunction was detected at a single time point using local measurements and uNGAL. For the detection of a rapid decline in kidney function over time, at least 2 more measurements at six and twelve months are needed.

Abstract Chronic Kidney Disease of unknown aetiology (CKDu) is a major health concern in North Central Province (NCP) of Sri Lanka. Anuradhapura and Polonnaruwa are the two most affected districts in NCP. This research was designed to identify main suspected CKDu causative agents in drinking water in NCP. Drinking water samples were collected from shallow wells of CKDu patients and non-patients in Anuradhapura and Polonnaruwa districts. They were tested for chemical ions: chloride, fluoride, nitrate, phosphate, calcium, magnesium, sodium, cadmium and arsenic. An analytical framework was developed to analyse water quality data using statistical methods, namely univariate analysis of variance (ANOVA) and Dunnett’s T3 post hoc test, Kruskal–Wallis (KW) and Mann–Whitney’s post hoc test, discriminant analysis, factorial analysis followed by reliability tests. ANOVA, KW and their post hoc tests were applied to show the significant differences at p

It is well known that climate change greatly affects human health, even though there are few studies on renal outcomes. Heat waves have been found to increase cardiovascular and respiratory morbidity and mortality, as well as the risk of acute renal failure and hospitalisation due to renal diseases, with related mortality. Recurrent dehydration in people regularly exposed to high temperatures seems to be resulting in an unrecognised cause of proteinuric chronic kidney disease, the underlying pathophysiological mechanism of which is becoming better understood. However, beyond heat waves and extreme temperatures, there is a seasonal variation in glomerular filtration rate that may contribute to the onset of renal failure and electrolyte disorders during extremely hot periods. Although there are few references in the literature, serum sodium disorders seem to increase. The most vulnerable population to heat-related disease are the elderly, children, chronic patients, bedridden people, disabled people, people living alone or with little social contact, and socioeconomically disadvantaged people.

Abstract Background Physical and psychological symptoms are among main manifestations of Chronic Kidney Disease (CKD). This study aimed to assess the symptom burden and self-perceived severity of symptoms among CKD patients living in a district in Sri Lanka. Method A community based cross-sectional study included a sample of randomly selected 1174 CKD patients from all 19 Medical Officer of Health areas in the district of Anuradhapura. Trained para-medical staff visited the households and administered the locally validated questionnaire to assess the presence and severity of symptoms. The inquiry was on 25 symptoms in a 5 point Likert scale indicating the severity during the previous week. Symptom burden score was constructed by summing each symptom severity score which ranged from 0 to 125. Results A total of 1118 CKD patients participated with a response rate of 95.2%. The mean age was 58.3 (SD 10.8) years and 62.7% were males. A majority were in CKD stage 4 (58.3%). Bone/joint pain was the most experienced symptom (87.6%; 95%CI 85.6–89.5). Loss of libido was the most severe symptom. The median symptom burden score was 35.0 (IQR 20.0–50.0). Multiple linear regression revealed education up to Advanced Level (β −9.176), CKD stage V (β 3.373), being dialyzed (β 20.944), comorbidities (β 4.241) and being employed (β −9.176) to be significant predictors of symptom burden. Conclusions Patients in all stages of CKD experience high symptom burden warranting rigorous measures to relieve symptoms and to improve the well-being of CKD patients.

Abstract Background The disabling symptoms, various food and fluid restrictions, restrictions to social life and stigma and taboos attached to Chronic Kidney Disease (CKD), have shown to pose a significant bearing on a patient’s Quality of Life (QOL). In the present study the Kidney Disease QOL-Short Form (KDQOL-SF™) was culturally adapted, modified and translated into Sinhala and validity and reliability were assessed. Method The process to culturally adapt the Kidney Disease Specific Component (KDSC) of KDQOL-SF™ was carried out by the modified Delphi process with a group of experts. The construct validity of the KDSC was assessed using Exploratory Factor Analysis (EFA). Appraising construct validity of SF-36 component of KDQOL-SF™ was done by assessing the convergent and discriminant validity using the Multitrait-Multimethod Matrix technique (MTMM). Randomly selected 250 CKD patients attending the five renal clinics in Polonnauwa were used to assess the construct validity. To assess the test-retest reliability of the instrument, within a period of one week, 30 randomly selected study participants were visited at their households. Results Two hundred and fifty adults with documented evidence of CKD participated. The EFA carried out using principal component factoring method and rotated by Varimax orthogonal method resulted in 14 factors with Eigen values ranging from 1.062–8.746. This 14 factor model explained 84.1% of total variance of the initial system. The communalities extracted for domains were all close to one. All the items were loaded to one or more domains with factor coefficients of more than 0.4, not requiring any of the items to be dropped. Few items which showed similarly high factor coefficients in more than one factor were assigned to a factor ensuring the pattern in the theoretical framework of the questionnaire based on expert opinion and vigorous analysis of literature. Convergent and divergent validity assessed using MTMM, revealed satisfactory construct validity. Cronbach’s alpha of all domains of KDQOL-SF™ except for cognitive function and Social function, exceeded Nunnally's criteria of 0.7. The Intra class Correlation Coefficients (ICC) were more than 0.8 for all the domains, which indicated good test re-test reliability. Conclusions KDQOL-SF™ is a valid and reliable instrument which can be used to assess QOL of CKD patients in Sri Lanka.

This paper examines how people in Anuradhapura District in Sri Lanka affected by endemic chronic kidney disease of unknown aetiology (CKDu) explain the factors causing the illness and their cultural meanings. The research found that the issue of contaminated water raised by the local community and the cultural meaning of water have influenced the government policy, health programmes, research agendas and the work of the media. Media reports on sociocultural, biomedical and epidemiological research into the aetiology of kidney disease have strengthened the perspective of the villagers who believe that polluted water has a direct relationship to kidney disease. This new understanding among villagers in Anuradhapura District has led to changes in their behaviours relating to the use and consumption of water, an important factor that has reinforced existing social hierarchies. [ABSTRACT FROM AUTHOR]

Background: After two-years of follow-up of 263 apparently healthy 18- to 30-year-old men in communities affected by Mesoamerican nephropathy (MeN), we identified three distinct case groups: a subgroup with (i) established renal dysfunction (case-group 1); individuals with (ii) a rapid decline in kidney function (case-group 2); and individuals with (iii) stable kidney function (non-cases). This paper investigates whether local tests are potentially useful for the timely identification of these case groups.Methods: Creatinine levels were measured in local laboratories every six months for two years. Aliquots were sent to a centralized laboratory for measurements of cystatin C and creatinine levels. We investigated agreement between the locally and centrally measured creatinine-based Chronic Kidney disease Epidemiology Collaboration (CKD-EPI) equation for estimating the Glomerular Filtration Rate (eGFR). A logistic regression analysis was used to assess predictive factors for case groups 1 and 2 compared to non-cases. Predictive variables were locally measured eGFR, and urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels. The discrimination performance of the model was assessed using the area under the receiver operating characteristic curve (AUC).Results: Considerable variation in local eGFR measurements was observed. The prediction model for case-group 1 included baseline kidney function and with or without uNGAL (AUC = 0.98, 95% confidence interval (CI), 0.91-1.00). The prediction model for case-group 2 also required eGFRScr at six and twelve months after baseline, with or without uNGAL levels (AUC = 0.88; 95% CI 0.80-0.99).Conclusions: Established renal dysfunction was detected at a single time point using local measurements and uNGAL. For the detection of a rapid decline in kidney function over time, at least 2 more measurements at six and twelve months are needed. [ABSTRACT FROM AUTHOR]

Objective: Chronic Kidney Disease (CKD) is known to adversely affect mental health. The study was aimed at estimating the prevalence of depression and psychological distress and the associated factors among CKD patients living in Anuradhapura, a rural district in Sri Lanka.Method: A community-based, cross-sectional study included a representative sample of 1174 CKD patients, drawn proportionately from all registered patients in all 19 Medical Officer of Health areas in the district of Anuradhapura. Trained paramedical staff visited the households and administered the locally validated Centre for Epidemiologic Studies Depression Scale and General Health Questionnaire-12 to screen for depression and psychological distress. Information related to associated factors was obtained through an interviewer-administered questionnaire.Results: A total of 1118 CKD patients participated, with a response rate of 95.2%. The mean age was 58.3 (SD 10.8) years. 62.7% of participants were males. The majority of participants was in CKD stage 4 (58.3%). The screening revealed that 75.0% (95% CI 72.5-77.5) of participants were psychologically distressed while 65.2% (95%CI 62.4-68.0) were found to be depressed. Multiple logistic regression analysis revealed advanced age, unemployment and poor health related quality of life contributed significantly to both depression and psychological distress.Conclusion: Depression and psychological distress were significant in this community. Policymakers should consider the likely high prevalence of psychological distress and depression among CKD patients as well as the need for specific mental health services to confirm diagnosis and initiate effective management. Identified associated factors should be used to identify targeted preventative interventions. [ABSTRACT FROM AUTHOR]

Chronic kidney disease of unknown aetiology (CKDu) refers to the epidemic level of incidence of CKD in several low- and middle-income countries, usually near the equator, for which the aetiology has not been identified. CKDu represents a form of CKD hotspot, defined as a country, region, community or ethnicity with a higher than average incidence of CKD. In terms of the number of persons affected, the so-called hypertensive nephropathy of African Americans probably represents the largest CKD hotspot, which is largely driven by variants of the APOL1 gene, questioning the very existence of hypertensive nephropathy and illustrating how kidney disease driven by genetic predisposition may underlie some forms of hypertension. For CKDu, hard physical work leading to dehydration (the first global warming-related disease?) and local toxins are leading aetiological candidates. Meso-American nephropathy is probably the best-characterized CKDu. In this issue of CKJ, a systematic review and meta-analysis by Gonzalez et al. identified positive associations between Meso-American nephropathy and male gender, family history of CKD, high water intake and lowland altitude. We now discuss the potential relationship of family history to genetic predisposition and how a better understanding of CKDu may help advance the aetiological characterization of the nearly 50% of end-stage renal disease patients worldwide that have no known cause for CKD or have been assigned non-specific diagnoses. [ABSTRACT FROM AUTHOR]

Background: Physical and psychological symptoms are among main manifestations of Chronic Kidney Disease (CKD). This study aimed to assess the symptom burden and self-perceived severity of symptoms among CKD patients living in a district in Sri Lanka.Method: A community based cross-sectional study included a sample of randomly selected 1174 CKD patients from all 19 Medical Officer of Health areas in the district of Anuradhapura. Trained para-medical staff visited the households and administered the locally validated questionnaire to assess the presence and severity of symptoms. The inquiry was on 25 symptoms in a 5 point Likert scale indicating the severity during the previous week. Symptom burden score was constructed by summing each symptom severity score which ranged from 0 to 125.Results: A total of 1118 CKD patients participated with a response rate of 95.2%. The mean age was 58.3 (SD 10.8) years and 62.7% were males. A majority were in CKD stage 4 (58.3%). Bone/joint pain was the most experienced symptom (87.6%; 95%CI 85.6-89.5). Loss of libido was the most severe symptom. The median symptom burden score was 35.0 (IQR 20.0-50.0). Multiple linear regression revealed education up to Advanced Level (β -9.176), CKD stage V (β 3.373), being dialyzed (β 20.944), comorbidities (β 4.241) and being employed (β -9.176) to be significant predictors of symptom burden.Conclusions: Patients in all stages of CKD experience high symptom burden warranting rigorous measures to relieve symptoms and to improve the well-being of CKD patients. [ABSTRACT FROM AUTHOR]

Background: The disabling symptoms, various food and fluid restrictions, restrictions to social life and stigma and taboos attached to Chronic Kidney Disease (CKD), have shown to pose a significant bearing on a patient's Quality of Life (QOL). In the present study the Kidney Disease QOL-Short Form (KDQOL-SF™) was culturally adapted, modified and translated into Sinhala and validity and reliability were assessed.Method: The process to culturally adapt the Kidney Disease Specific Component (KDSC) of KDQOL-SF™ was carried out by the modified Delphi process with a group of experts. The construct validity of the KDSC was assessed using Exploratory Factor Analysis (EFA). Appraising construct validity of SF-36 component of KDQOL-SF™ was done by assessing the convergent and discriminant validity using the Multitrait-Multimethod Matrix technique (MTMM). Randomly selected 250 CKD patients attending the five renal clinics in Polonnauwa were used to assess the construct validity. To assess the test-retest reliability of the instrument, within a period of one week, 30 randomly selected study participants were visited at their households.Results: Two hundred and fifty adults with documented evidence of CKD participated. The EFA carried out using principal component factoring method and rotated by Varimax orthogonal method resulted in 14 factors with Eigen values ranging from 1.062-8.746. This 14 factor model explained 84.1% of total variance of the initial system. The communalities extracted for domains were all close to one. All the items were loaded to one or more domains with factor coefficients of more than 0.4, not requiring any of the items to be dropped. Few items which showed similarly high factor coefficients in more than one factor were assigned to a factor ensuring the pattern in the theoretical framework of the questionnaire based on expert opinion and vigorous analysis of literature. Convergent and divergent validity assessed using MTMM, revealed satisfactory construct validity. Cronbach's alpha of all domains of KDQOL-SF™ except for cognitive function and Social function, exceeded Nunnally's criteria of 0.7. The Intra class Correlation Coefficients (ICC) were more than 0.8 for all the domains, which indicated good test re-test reliability.Conclusions: KDQOL-SF™ is a valid and reliable instrument which can be used to assess QOL of CKD patients in Sri Lanka. [ABSTRACT FROM AUTHOR]

Background Several primary studies have looked at the burden of chronic kidney disease among diabetic patients, but their results have shown significant variance in India. In order to determine the combined prevalence of chronic kidney disease and associated risk factors among patients with diabetes, this study used a combination of methods. Methods Over the course of two years, a cross-sectional observational study was undertaken in the Tertiary Care Teaching Hospital's Department of General Medicine including all chronic kidney disease patients of 18 years of age and above of either gender. People not suffering from the disease were chosen as controls. Kidney Injury Molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin-ELISA (NGAL-ELISA) sample analysis by the kit method was done. The study was carried out in accordance with Schedule Y, ICH GCP principles, and the Helsinki Declaration after receiving approval from the institutional ethics committee. Results In our study, the urinary mean KIM-1 was 49.75±4.35 μg/g Cr in the Chronic Kidney Disease of Unknown etiology (CKDu) group and 1.43±0.15 μg/g Cr in the controls group. The mean NGAL levels of the CKDu Group and the controls group were 8.94±1.31 μg/g and 0.41±0.05 μg/g, respectively. In CKDu and the controls group, the mean eGFR (ml/min/1.73m 2 ) was 69.83±7.91 and 108±3.7, respectively. The mean serum creatinine (mg/dL) was reported 3.79 in the CKDu group and 1.0 in the controls group. Conclusion Despite the urban centers previously being thought of as a non-endemic location, for the first time in the city, 60 CKDu patients are reported in this study. This is the first study to use the urinary biomarkers KIM-1 and NGAL to find suspected cases of CKDu and early kidney damage in local communities in the urban centers., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mughni et al.)

The recent emergence of an apparently new form of chronic kidney disease of unknown aetiology (CKDu) has become a serious public health crisis in Sri Lanka. CKDu is slowly progressive, irreversible, and asymptomatic until late stages, and is not attributable to hypertension, diabetes, or other known aetiologies. In response to the scope and severity of the emerging CKDu health crisis, the Sri Lanka Ministry of Health and the World Health Organization initiated a collaborative research project from 2009 through 2012 to investigate CKDu prevalence and aetiology. The objective of this paper is to discuss the recently published findings of this investigation and present additional considerations and recommendations that may enhance subsequent investigations designed to identify and understand CKDu risk factors in Sri Lanka or other countries. [ABSTRACT FROM AUTHOR]

Mesoamerican nephropathy (MeN) or chronic kidney disease of unknown origin (CKDu) is a rising epidemic in hotspot regions of El Salvador and Nicaragua. MeN is often defined in patients who exhibit a clinically reduced estimated glomerular filtration rate (eGFR) but lack a defining etiology such as diabetes or hypertension. A multitude of risk factors for MeN have been identified, including physical labor demands in a hot climate, exposure to pesticides, and poverty. Additionally, social determinants such as limited access to health care and the cost of disease burden often contribute to overall poor prognosis and progression of the disease. We present a case of a 39-year-old male with a past medical history of gout who presented to the emergency room with abdominal pain radiating to the flanks and bilateral great toe pain. Social history revealed the patient recently moved to the United States from Central America (Nicaragua), was unemployed, and did not have health insurance. Prior to the presentation, the patient admitted he was not compliant with his gout medications for about one month. The symptoms first began two to three weeks prior to his evaluation in the emergency department; the patient also endorsed decreased oral intake during this time period. He was noted to have abnormally elevated creatinine along with elevated uric acid levels, low potassium and magnesium levels. Abdominal imaging revealed nephrolithiasis without hydronephrosis. Initial differentials included acute kidney injury (AKI) from dehydration, non-steroidal anti-inflammatory drug (NSAID) induced nephropathy, and uric acid nephropathy. This patient was eventually found to have a biopsy-proven findings of CKDu. We want to highlight the need to keep MeN high in the differential with a low threshold to perform a renal biopsy for accurate diagnosis and management of the disease, especially in the rising immigrant population in the United States., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Singh et al.)

Chronic Kidney Disease of unknown aetiology (CKDu) is a major health concern in North Central Province (NCP) of Sri Lanka. Anuradhapura and Polonnaruwa are the two most affected districts in NCP. This research was designed to identify main suspected CKDu causative agents in drinking water in NCP. Drinking water samples were collected from shallow wells of CKDu patients and non-patients in Anuradhapura and Polonnaruwa districts. They were tested for chemical ions: chloride, fluoride, nitrate, phosphate, calcium, magnesium, sodium, cadmium and arsenic. An analytical framework was developed to analyse water quality data using statistical methods, namely univariate analysis of variance (ANOVA) and Dunnett’s T3 post hoc test, Kruskal-Wallis (KW) and Mann-Whitney’s post hoc test, discriminant analysis, factorial analysis followed by reliability tests. ANOVA, KW and their post hoc tests were applied to show the significant differences at p < 0.05 in mean and median values of chemical constituents between CKDu patient and non-patient samples. Discriminant analysis was applied to show the degree of accuracy in original sampling groups. Factorial analysis was applied to identify the ion combinations in each group. A secondary set of data obtained from drinking water samples of CKDu endemic and non-endemic areas were also analysed independently using the same analytical techniques to compare the results. [ABSTRACT FROM AUTHOR]

It is well known that climate change greatly affects human health, even though there are few studies on renal outcomes. Heat waves have been found to increase cardiovascular and respiratory morbidity and mortality, as well as the risk of acute renal failure and hospitalisation due to renal diseases, with related mortality. Recurrent dehydration in people regularly exposed to high temperatures seems to be resulting in an unrecognised cause of proteinuric chronic kidney disease, the underlying pathophysiological mechanism of which is becoming better understood. However, beyond heat waves and extreme temperatures, there is a seasonal variation in glomerular filtration rate that may contribute to the onset of renal failure and electrolyte disorders during extremely hot periods. Although there are few references in the literature, serum sodium disorders seem to increase. The most vulnerable population to heat-related disease are the elderly, children, chronic patients, bedridden people, disabled people, people living alone or with little social contact, and socioeconomically disadvantaged people., (Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)