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Original ArticlesGlomerular and Tubulointerstitial Diseases
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Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka

Shuchi Anand, Maria E. Montez-Rath, Dinuka Adasooriya, Neelakanthi Ratnatunga, Neeraja Kambham, Abdool Wazil, Sulcohana Wijetunge, Zeid Badurdeen, Charaka Ratnayake, Nishamani Karunasena, Stephen L. Schensul, Penny Valhos, Lalarukh Haider, Vivek Bhalla, Adeera Levin, Paul H. Wise, Glenn M. Chertow, Michele Barry, Andrew Z. Fire and Nishantha Nanayakkara
CJASN February 2019, 14 (2) 224-232; DOI: https://doi.org/10.2215/CJN.07430618
Shuchi Anand
Division of Nephrology and Departments of
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Maria E. Montez-Rath
Division of Nephrology and Departments of
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Dinuka Adasooriya
Kandy Teaching Hospital, Kandy, Sri Lanka;Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
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Neelakanthi Ratnatunga
Department of Pathology, University of Peradeniya, Kandy, Sri Lanka;
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Neeraja Kambham
Pathology,
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Abdool Wazil
Kandy Teaching Hospital, Kandy, Sri Lanka;
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Sulcohana Wijetunge
Department of Pathology, University of Peradeniya, Kandy, Sri Lanka;
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Zeid Badurdeen
Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
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Charaka Ratnayake
Kandy Teaching Hospital, Kandy, Sri Lanka;
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Nishamani Karunasena
Kandy Teaching Hospital, Kandy, Sri Lanka;
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Stephen L. Schensul
Department of Community Medicine and Health Care and
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Penny Valhos
Department of Marine Sciences, University of Connecticut, Groton, Connecticut; and
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Lalarukh Haider
Division of Nephrology, University of Connecticut Health Center, Farmington, Connecticut;
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Vivek Bhalla
Division of Nephrology and Departments of
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Adeera Levin
Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Paul H. Wise
Pediatrics, and
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Glenn M. Chertow
Division of Nephrology and Departments of
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Michele Barry
Medicine, Stanford University School of Medicine, Palo Alto, California;
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Andrew Z. Fire
Pathology,
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Nishantha Nanayakkara
Kandy Teaching Hospital, Kandy, Sri Lanka;Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
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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.

  • Prospective Studies
  • Tobacco
  • risk factors
  • Logistic Models
  • Farmers
  • Serum Albumin
  • Consensus
  • Sri Lanka
  • nephrology
  • Nephritis, Interstitial
  • kidney
  • Renal Insufficiency, Chronic
  • Biopsy
  • hypertension
  • diabetes mellitus
  • Life Style
  • Received June 21, 2018.
  • Accepted October 30, 2018.
  • Copyright © 2019 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 14 (2)
Clinical Journal of the American Society of Nephrology
Vol. 14, Issue 2
February 07, 2019
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Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka
Shuchi Anand, Maria E. Montez-Rath, Dinuka Adasooriya, Neelakanthi Ratnatunga, Neeraja Kambham, Abdool Wazil, Sulcohana Wijetunge, Zeid Badurdeen, Charaka Ratnayake, Nishamani Karunasena, Stephen L. Schensul, Penny Valhos, Lalarukh Haider, Vivek Bhalla, Adeera Levin, Paul H. Wise, Glenn M. Chertow, Michele Barry, Andrew Z. Fire, Nishantha Nanayakkara
CJASN Feb 2019, 14 (2) 224-232; DOI: 10.2215/CJN.07430618

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Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka
Shuchi Anand, Maria E. Montez-Rath, Dinuka Adasooriya, Neelakanthi Ratnatunga, Neeraja Kambham, Abdool Wazil, Sulcohana Wijetunge, Zeid Badurdeen, Charaka Ratnayake, Nishamani Karunasena, Stephen L. Schensul, Penny Valhos, Lalarukh Haider, Vivek Bhalla, Adeera Levin, Paul H. Wise, Glenn M. Chertow, Michele Barry, Andrew Z. Fire, Nishantha Nanayakkara
CJASN Feb 2019, 14 (2) 224-232; DOI: 10.2215/CJN.07430618
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Keywords

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

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