Abstract

Chronic kidney disease of unknown etiology (CKDu) is a major health issue in agricultural areas in Sri Lanka. Despite many attempts to identifying causative factors of CKDu, the real cause/s remain/s elusive to date. Understanding the progression of potential etiologies may provide valuable insight into this quest. Literature relevant to CKDu addresses several etiologies, including quality of drinking water in the affected areas including hardness, fluoride, ionicity, agrochemical and heavy metal contaminations, consumption of contaminated food, and the genetic makeup of vulnerable populations. Progression of the etiologies revealed persistent interest in heavy metals of multiple origins: waterborne, foodborne, or soilborne. Secondary factors, such as water hardness, fluoride, and ionicity appear to act synergistically, aggravating the role of heavy metals on the onset, and the progression of CKDu. Demographical factors, such as male sex, over 50 years of age, agriculture-related occupation, and the consumption of contaminated water and food are intricately related with the disease progression while other minor risk factors such as smoking, alcohol consumption, etc. exasperate the disease condition. Since, none of these etiologies are examined adequately, conducting laboratory exposure studies under in-vivo and in-vitro settings to understand their role in CKDu is crucial.

摘要

病因不明的慢性肾脏病 (CKDu) 是斯里兰卡农业地区的主要健康问题。尽管进行了许多尝试来确定 CKDu 的致病因素，但真正的原因迄今为止仍然难以捉摸。了解潜在病因的进展可能会为这一探索提供有价值的见解。与 CKDu 相关的文献涉及多种病因，包括受影响地区的饮用水质量，包括硬度、氟化物、离子性、农用化学品和重金属污染、受污染食物的消费以及易感人群的基因组成。病因学的进展揭示了对多种来源的重金属的持续兴趣：水源性、食源性或土壤源性。次要因素，如水硬度、氟化物和离子性似乎协同作用，加重重金属对 CKDu 的发病和进展的作用。人口统计学因素，如男性、50 岁以上、农业相关职业、食用受污染的水和食物与疾病进展错综复杂，而其他轻微的危险因素如吸烟、饮酒等则加剧了疾病的恶化。病况。由于这些病因均未得到充分检查，因此在以下条件下进行实验室暴露研究了解它们在 CKDu 中的作用的体内和体外环境至关重要。