Chronic Kidney Disease of Unknown Etiology: Hotspots in India and Other Asian Countries
Section snippets
POPULATIONS AFFECTED
Most of the regions affected in India are rural areas with scarce nephrology care.5 CKDu is a major public health problem in the Uddanam region in the north-central districts of Andhra Pradesh, consisting of the mandals (subdistricts) of Kaviti, Sompeta, Kanchili, Ithapuram, Palasa, and Vajrapukkoturu, accounting for more than 100 villages and a population of approximately 150,000.6 The name Uddanam (derived from the Sanskrit word “Udhyanam,” meaning garden) is given because the area is close
ETIOLOGIC FACTORS
There are a paucity of robust data on the etiologic factors. A systematic search has failed to provide a consensus on a single causative agent, and thus several factors have been proposed, as shown in Table 1. In Mesoamerican nephropathy, heat stress, heavy physical activity, and severe dehydration may have led to multiple episodes of subclinical acute kidney injury,10 generation of reactive oxidants, and tubular injury. Other proposed mechanisms include hyperuricemia, rhabdomyolysis, and
MANAGEMENT OF CKDu
Management of the CKDu epidemic should involve the following components.
- 1.
Awareness, screening, and surveillance of the affected community;
- 2.
Identification of the affected population in the geographic areas and categorization into CKD stages;
- 3.
Lifestyle modification, such as avoidance of smoking and chemically flavored betel nut chewing;
- 4.
Safe drinking water supply;
- 5.
Avoidance of nephrotoxic agents, such as nonsteroidal anti-inflammatory drugs and alternative therapy;
- 6.
Dietary advice regarding
SCREENING
Screening for early detection of kidney impairment should be instituted in these areas with serum creatinine concentration, fasting blood glucose level, blood pressure measurement, body mass index, and a urine dipstick for albuminuria. The average cost of kidney disease–related laboratory screening per person in India is approximately Indian Rupees 200 (approximately US $3). The lack of frank albuminuria poses a challenge to early detection of CKDu. Community ultrasound screening per person for
INTERVENTIONS IN AFFECTED PEOPLE
Use of clean water for drinking and cooking purposes, avoidance of nephrotoxic agents and alternative medicines, and avoidance of exposure to pesticides and agrochemicals are important measures that need to be instituted in these hotspots to address factors that may contribute to the progression of CKDu. For this to happen, efficient government machinery with public-private partnership is needed. For people affected with CKDu, anemia correction, skilled dietary advice, and regular follow-up
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