Sunday, March 20, 2011

CHRONIC KIDNEY DISEASE IN SRI LANKA


Chronic kidney disease is a major health problem in Sri Lanka since in last 8-10 years. CKDu or chronic kidney disease of unknown aetiology is characteristic from other kidney disease by its slow progressive asymptomatic development. This disease start at a younger age group and it is common among people who engaged in agriculture typically around age 40-60 years
In chronic kidney disease kidney dose not usually fail at once instead it slowly stepwise fail to perform it tasks  chronic kidney disease involves 5 stages. Therefore stage 5 chronic kidney disease is also referred to as kidney failure, end-stage kidney disease, or end-stage renal disease, wherein there is total or near-total loss of kidney function. There is dangerous accumulation of water, waste, and toxic substances, and most individuals in this stage of kidney disease need dialysis or transplantation to stay alive.

Table 1. Stages of Chronic Kidney Disease

Stage
Description
GFR*
mL/min/1.73m2
1
Slight kidney damage with normal or increased filtration
More than 90
2
Mild decrease in kidney function
60-89
3
Moderate decrease in kidney function
30-59
4
Severe decrease in kidney function
15-29
5
Kidney failure
Less than 15 (or dialysis)

"GFR level," or glomerular filtration rate, is a measure of how well your kidneys are cleaning your blood. Your doctor can calculate your GFR, based on a formula.
 As I mention early CKDu is common among people who involve in agriculture. Geographically it is distributed in North central region ( North central province, part of North  weston and part of Uva province) like Medawachchiya, Padaviya, Dehiaththakandiya.
            Since CKDu is a major helth problem in Sri Lanka, Sri Lankan government try to identify the prevalence and main determinant of the chronic kidney disease. In this process researches and local authorities are mainly consider about
            • Case Control study
            • Cohort study 
            • Renal biopsy study (tissue and data collection) 
            • Environmental study group for case control phase of the study
            • Environmental study group for analysis of water for case 
            • control study
            • Post mortem study group (collection of organs and data) 
            • Human tissue (post mortem), urine and blood analysis study
            • Chronic Kidney Disease registry and Geographical Mapping study
            • Study group for analysis of animal tissues study
            • Nutrition and Sociology Study
           Even though several studies have been conducted  main reason for CKDu is not yet verified by any research group that are involve in CKDu researches. But there are some acceptable explanations and theories associated with CKDu

                    01. Excessive quantities of naturally found fluoride in the ground water which can harm the kidney. 
                   02. Excessive use of fertilizers, Insecticides, and weedicides. 
                   03. The use of aluminum utensils made out of low quality cheap Aluminum to store water and to prepare food. The fluoride content found in the groundwater reacts with the Aluminum creating Toxic compounds (ALF x) 
                   04. Entry of Toxic element such as Cadmium via food chain 
                   05. Excessive consumption of poor quality illegal liquor. 
           Other than these explanations mycotoxins, use of herbal/ ayurvedic medicine, smoking and history of snakebite are some other factors to be considered. A combination of two or more of above factors possibly a synergistic effect. Or chemical substance form by combining agrochemical derivatives and naturally found Fluoride could also be responsible.

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