Prevalence of Chronic Kidney Disease of Uncertain Etiology Within Selected Farming Communities in Rural Sri Lanka.

Background: Chronic kidney disease of uncertain etiology (CKDu) is an emergent health concern, particularly in tropical farming communities in several global hotspots, including Sri Lanka. This particular nephropathy is characterized by a progressive decline in kidney function in the absence of conventional chronic kidney disease (CKD) risk factors such as diabetes mellitus, hypertension, and other identifiable kidney disorders. As it is almost asymptomatic at early stages, CKDu is mostly diagnosed at late stages with significant kidney damage. Hence, the identification of disease susceptibility and vulnerable communities at the earliest possible instances is highly important for the management of the disease. Objective: We aimed to compare kidney health across three different farming communities in Sri Lanka to identify CKDu susceptibilities. Methods: A cross-sectional study was performed with three selected farming communities: paddy farmers (PF; N = 581), sugarcane farmers (SF; N = 550), and vegetable farmers (VF; N = 244) in comparison with an age-matched control group of nonfarming (NF; N = 225) individuals. A medical examination was performed to investigate health status and medical history, whereas a urinalysis was performed to determine creatinine and albumin contents. Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR) were used for assessment of kidney function. CKDu susceptibility was determined based on eGFR, and urinary ACR adhering to the clinical practice guidelines in Sri Lanka. Results: The median (interquartile range [IQR]) eGFR levels of PF (85 mL/min/1.73 m2 [72-97]) and SF (93 mL/min/1.73 m2 [73-112]) were significantly lower than that of the NF group (103 mL/min/1.73 m2 [87-125]) (P < .0001), whereas eGFR of VF (100 mL/min/1.73 m2 [80-111]) was not significantly different compared with NF. The median (IQR) urinary ACR levels of the study groups, PF, SF, VF, and NF, were 0.59 (0.26-1.45), 0.46 (0.28-0.88), 0.45 (0.34-0.90), and 0.44 (0.34-1.02) mg/mmol, respectively. However, urinary ACR did not differ significantly across the study groups (P > .05). The prevalence of CKDu within PF (13.60%), SF (12.54%), and VF (6.67%) communities was significantly higher (P < .05) compared with the NF (2.67%). Of the total CKD cases, CKDu susceptible cases represented 73%, 69%, 50%, and 25% in PF, SF, VF, and NF, respectively, indicating a high risk of CKDu susceptibility among farming communities. Moreover, a noteworthy association of CKDu was observed with agrochemical exposure (odds ratio [OR] = 3.11, 95% confidence interval [CI] = 1.36-7.09). Concerning the farming practices, sugarcane farming showed the highest association with CKDu prevalence (OR = 3.40, 95% CI = 1.49-7.78). Conclusions: Compared with the nonfarming group, a significant risk of CKDu was observed in the three farming communities, particularly among paddy and sugarcane farmers. Longitudinal epidemiological studies to identify vulnerable farming communities and associated risk factors are critically needed to develop effective management strategies against CKDu within farming communities.

Contexte: L'insuffisance rénale chronique d'étiologie incertaine (IRCi) est un problème de santé émergent, en particulier dans les collectivités agricoles de plusieurs régions tropicales dans le monde, dont le Sri Lanka. Cette néphropathie particulière se caractérise par un déclin progressif de la fonction rénale en absence de facteurs de risque classiques de l'IRC comme le diabète, l'hypertension et d'autres troubles rénaux identifiables. L'IRCi étant quasi asymptomatique dans les stades précoces, elle est souvent diagnostiquée à des stades avancés et en présence de lésions rénales importantes. Il serait donc très pertinent d'identifier les populations vulnérables et d'évaluer le plus tôt possible leur prédisposition à l'IRCi, afin de faciliter la prise en charge de la maladie. Objectif: Notre objectif était de comparer la santé rénale de trois différentes populations agricoles du Sri Lanka afin d'évaluer leur prédisposition à l'IRCi. Méthodologie: Une étude transversale a été réalisée auprès de trois populations agricoles, soit les cultivateurs de riz (CR; n=581), de canne à sucre (CCS; n=550) et de légumes (CL; n=244). Les groupes étudiés ont été comparés à un groupe témoin d'individus non-agriculteurs (NA; n=225) d'âge similaire. Les sujets se sont soumis à un examen de leur état de santé et leurs antécédents médicaux, ainsi qu'à une analyse d'urine pour déterminer leurs taux urinaires de créatinine et d'albumine. Le débit de filtration glomérulaire estimé (DFGe) et le rapport albumine-créatinine urinaire (RAC) ont servi à évaluer la fonction rénale. La prédisposition à l'IRCi a été établie sur la base du DFGe et du RAC urinaire, conformément aux recommandations de pratique clinique au Sri Lanka. Résultats: Le DFGe médian (ÉIQ) des CR (85 ml/min/1,73 m2 [72-97]) et des CCS (93 ml/min/1,73 m2 [73-112]) était significativement inférieur à celui du groupe témoin (103 ml/min/1,73 m2 [87-125]) (p < 0.0001); aucune différence significative n'a été observée pour le groupe des CL (100 ml/min/1,73 m2 [80-111]). Le RAC urinaire médian (ÉIQ) s'établissait à 0,59 mg/mmol (0,26-1,45) pour les CR, à 0,46 mg/mmol (0,28-0,88) pour les CCS, à 0,45 mg/mmol (0,34-0,90) pour les CL et à 0,44 mg/mmol (0,34-1,02) pour le groupe témoin; soit aucune différence significative pour le RAC urinaire entre les groupes à l'étude (p > 0.05). La prévalence de l'IRCi dans les populations de CR (13,60 %), de CCS (12,54 %) et de CL (6,67 %) était significativement plus élevée (p < 0.05) que dans le groupe témoin (2,67 %). Sur le total des cas d'IRC, ceux qui montraient une prédisposition à l'IRCi représentaient 73 % (CR), 69 % (CCS), 50 % (CL) et 25 % (NA) des cas d'IRC de chaque groupe, ce qui indique un risque élevé de prédisposition à l'IRCi dans les communautés agricoles. On a en outre observé une association notable entre l'IRCi et l'exposition aux agents agrochimiques (RC : 3,11 [IC 95 % : 1,36-7,09]). En ce qui concerne les différentes pratiques agricoles, la culture de la canne à sucre a montré la plus forte association avec la prévalence d'IRCi (RC : 3,40 [IC 95 % : 1,49-7,78]). Conclusion: Un risque significativement plus élevé d'IRCi a été observé dans les trois communautés agricoles par rapport au groupe des non-agriculteurs, en particulier chez les cultivateurs de riz et de canne à sucre. Il est essentiel de procéder à des études épidémiologiques longitudinales visant à identifier les communautés agricoles vulnérables et les facteurs de risque associés, afin d'élaborer des stratégies efficaces pour prévenir l'IRCi au sein de ces communautés.

Apparent oliguria following urological surgery.

Oliguria is a common feature of acute kidney injury (AKI), but should be interpreted in the context of other biochemical markers when diagnosing and monitoring AKI or considering the need for renal support. We report an unusual case of apparent severe oliguria arising as a result of complex urological pathology and discuss how an understanding of creatinine kinetics raised suspicions of an alternative diagnosis. We discuss the problems caused by an over-reliance on urine output or serum creatinine alone when diagnosing and staging AKI and highlight the need for a more holistic approach.

Lower urinary tract symptoms; an undetected cause for morbidity in adults.

INTRODUCTION: Lower urinary tract symptoms (LUTS) have been recognised as a cause of distress among adult men and women. In view of the increasing elderly population in Sri Lanka, the number of individuals with LUTS is likely to increase. OBJECTIVES: To determine the prevalence and severity of LUTS in a community sample of older men and women residing in an urban area. DESIGN: Cross-sectional descriptive study. SETTING: Field practice area of National Institute of Health Sciences, Kalutara. METHODS: Households were selected using probability proportionate to the size (PPS) method. 985 adult men and women (above 40 years of age) were interviewed by Public Health Midwives regarding LUTS using an interviewer-administered questionnaire. The questions were adapted from ICSmale questionnaire and the Bristol Female Lower Urinary Tract questionnaire. RESULTS: 209 (47%) men and 338 (62.6%) women reported at least one urinary symptom. In men, urgency, nocturia, dysuria and frequency were the most prevalent symptoms with stress incontinence being the least prevalent. Majority of the symptoms showed an increase in prevalence with age. In women, dysuria, stress incontinence, urgency and frequency were the most prevalent symptoms. Hesitancy, intermittency, and stress and urge incontinence were the most bothersome symptoms among men, and urge and stress incontinence among women. CONCLUSIONS: Prevalence of LUTS was high in our study population.

Patterns of disease among adults hospitalized with dengue infections.

BACKGROUND: Recent years have seen an increase in dengue infections among adults in Sri Lanka, with similar trends seen in many other countries. Data on the natural history and outcome of dengue in adults are quite limited. AIM: To study clinical and laboratory findings in adult dengue patients hospitalized in Sri Lanka during a recent major dengue epidemic. DESIGN: Prospective observational study. METHODS: Clinical, laboratory and demographic information were collected from adult patients with confirmed dengue infections (n = 108) treated in a general medical ward in Sri Lanka from 24 April to 31 July 2004. RESULTS: There were 68 male and 40 female patients, mean age 26.6 years. Dengue fever (DF) was seen in 33 (30.6%) and dengue haemorrhagic fever (DHF) in 75 (69.4%). Of the 37 (34.3%) with primary dengue infections, 19 (51.4%) developed DF and 18 (48.6%) developed DHF. Overall, 42 patients (38.9%) had bleeding manifestations. These adults showed differences in clinical and laboratory findings, disease severity and mortality, compared to children seen during the same epidemic. Secondary dengue infections were significantly associated with development of severe disease (OR 5.0, 95%CI 1.9-13.5, p < 0.001). Mortality was 3.7%. DISCUSSION: Pooling data on adult dengue patients from different regions should help us to understand the natural history of disease in this group. It would also help in developing evidence-based treatment guidelines and allocating limited and scarce health resources. Our data contribute towards this goal.

Banding of oesophageal varices using locally improvised materials.

Bleeding from oesophageal varices is the commonest cause of significant upper gastrointestinal bleeding in Sri Lanka. Endoscopic band ligation is an effective method in the management of varices. But the cost of banding equipment is high, unaffordable for a majority of our patients. We have devised a cheap method to carry out banding of varices. Banding of varices using this technique was carried out in 235 patients. In the patients who were followed up, there was a reduction in the size of varices across all grades of varices. No complications due to banding were noted, and only 10 patients developed re-bleeding. Since the initial experience on efficacy and safety of this technique is encouraging, we believe that its widespread adoption in Sri Lanka would be cost effective and life-saving.