Introduction: Chronic kidney disease of unknown etiology (CKDu) has emerged as a significant public health problem in Sri Lanka. The role of environmental exposure to cadmium and arsenic in the aetiology of CKDu is still unclear. Identification of a panel of novel urinary biomarkers would be invaluable in the study of toxin mediated damage postulated to be the aetiology of CKDu. Objectives: The aims of this study were to evaluate the profile of novel urinary biomarkers in CKDu patients and identify any association with environmental exposure to heavy metals. Methods: Thirty seven randomly selected CKDu patients attending a renal clinic in the North Central Province and two control groups namely a farmer group (n=39) and a non-farmer group (n=40) from a non-endemic area were included in this comparative cross sectional study. Urine samples were analyzed for heavy metals and five urinary biomarkers. Results: CKDu patients had significantly elevated urinary levels of fibrinogen (198.2 ng/mg creatinine p<0.001), clusterin (3479 ng/mg creatinine p<0.001), cystatin-C (5124.8 ng/mg creatinine p<0.001) and β2-microglobulin (9913.4 ng/mg creatinine p<0.001) compared to the control groups. Fibrinogen and β2-microglobulin were the best to discriminate CKDu patients from normal individuals with the receiver operator areas under the curve being 0.867 and 0.853, respectively. Urinary fibrinogen and KIM-1 levels correlated positively with urinary arsenic levels. KIM-1 levels correlated positively with urinary mercury and lead levels but no correlation was seen with urinary cadmium levels. Conclusions: Fibrinogen and β2-microglobulin have the potential of being a screening tool for detection of CKDu and may aid the early diagnosis of toxin mediated tubular injury in CKDu. Their usefulness need to be further validated in a larger epidemiological study of patients with early stages of CKDu.
Introduction: Chronic kidney disease of unknown etiology (CKDu) has emerged as a significant public health problem in Sri Lanka. The role of environmental exposure to cadmium and arsenic in the aetiology of CKDu is still unclear. Identification of a panel of novel urinary biomarkers would be invaluable in the study of toxin mediated damage postulated to be the aetiology of CKDu. Objectives: The aims of this study were to evaluate the profile of novel urinary biomarkers in CKDupatients and identify any association with environmental exposure to heavy metals. Methods: Thirty seven randomly selected CKDupatients attending a renal clinic in the North Central Province and two control groups namely a farmer group (n=39) and a non-farmer group (n=40) from a non-endemic area were included in this comparative cross sectional study. Urine samples were analyzed for heavy metals and five urinary biomarkers. Results:CKDupatients had significantly elevated urinary levels of fibrinogen (198.2 ng/mg creatinine p<0.001), clusterin (3479 ng/mg creatinine p<0.001), cystatin-C (5124.8 ng/mg creatinine p<0.001) and β2-microglobulin (9913.4 ng/mg creatinine p<0.001) compared to the control groups. Fibrinogen and β2-microglobulin were the best to discriminate CKDupatients from normal individuals with the receiver operator areas under the curve being 0.867 and 0.853, respectively. Urinary fibrinogen and KIM-1 levels correlated positively with urinary arsenic levels. KIM-1 levels correlated positively with urinary mercury and lead levels but no correlation was seen with urinary cadmium levels. Conclusions: Fibrinogen and β2-microglobulin have the potential of being a screening tool for detection of CKDu and may aid the early diagnosis of toxin mediated tubular injury in CKDu. Their usefulness need to be further validated in a larger epidemiological study of patients with early stages of CKDu.
Authors: E M D V Ekanayake; T D K S C Gunasekara; P Mangala C S De Silva; Sudheera Jayasinghe; E P S Chandana; Nishad Jayasundara Journal: Int J Environ Res Public Health Date: 2022-04-26 Impact factor: 4.614
Authors: Jessica H Leibler; Oriana Ramirez-Rubio; Juan José Amador Velázquez; Damaris López Pilarte; Wassim Obeid; Chirag R Parikh; Salini Gadupudi; Madeleine K Scammell; David J Friedman; Daniel R Brooks Journal: Pediatr Nephrol Date: 2020-06-05 Impact factor: 3.714
Authors: K S M Abdul; P Mangala C S De Silva; E M D V Ekanayake; W A K G Thakshila; S D Gunarathna; T D K S C Gunasekara; S S Jayasinghe; H B Asanthi; E P S Chandana; G G T Chaminda; S H Siribaddana; Nishad Jayasundara Journal: Int J Environ Res Public Health Date: 2021-03-22 Impact factor: 3.390
Authors: Eranga S Wijewickrama; W A Gayani Thakshila; E M Dilini Ekanayake; T D K Sameera Gunasekara; E P Saman Chandana; Sudheera S Jayasinghe; Thilanga Ruwanpathirana; Saroj Jayasinghe; Mangala C S De Silva Journal: Kidney Int Rep Date: 2022-08-03