this presentation is about chronic kidney disease in Srilanka all risk factors have analysed here

4. INTRODUCTION
Function of kidneys
• Filter out waste product from
blood
• Control blood pressure
• Make hormones
• Maintain salt and chemical in
right level

5. Gradual reductions of kidney functions without
showing Symptoms. This kind of abnormality
notice as Chronic Kidney Disease (CKDu),
First evidence 1950 Europe- Balkan region
Sri Lanka- 2000
Chronic: means ongoing ,
INTRODUCTION cont..

6. Major three causal factors
1) Fixed factors
2) Behavioral factors
3) Biomedical factors
INTRODUCTION cont..

7. Fixed factors
 Family history and genetic,
 Increasing age,
 Previous kidney damage,
 Low birth weight
 Male sex
INTRODUCTION cont..

8. Behavioral factors
Tobacco smoking,
physical inactivity a
 poor nutrition
Biomedical factors
Diabetes
 High blood pressure
 Cardiovascular disease
 Over weight and obesity
INTRODUCTION cont..

9. INTRODUCTION cont..
Blood test – creatinine
Glomerular Filtration Rate (GFR)
Urine analysis- Protein or red blood cells
Renal biopsy - removing a small sample of kidney
tissue

12. Definition
CKD is a progressive loss of renal function over a
period of months or years. The symptoms of
worsening kidney function are unspecific, and
might include feeling generally unwell and
experiencing a reduced appetite.
(www.wikipedia.org/wiki/Chronic kidney disease)
WHAT IS CKDu

13. SRILANKAN SITUATION
Identified year 2000
Last five years 6000 cases
Districts
 Anuradhapura
 Polonnaruwa
 Kurunegala
 Trincomale
 Ampara CKDu hot spot in SriLanka,
(Source:
http://www.docstoc.com/docs)

14. CADMIUM
(Source: www.jamesmbrown.co.uk/cd_pigments/cdconsump.gif)

15. CADMIUM CONT..
Natural cadmium levels in the environment
• Atmosphere 0.1 - 5 ng/m³
• Earth's crust 0.1 - 0.5 µg/g
• Marine sediment ~ 1 µg/g
• Sea water ~0.1 µg/l

16. URANIUM
No research in SriLanka
Positive relationship with CKDu (RNSA-UK)
Safety level 2µg/L to 30µg/L (WHO)
Some Dry zone soil (U) - 3.6mg/Kg
Triple Super Phosphate
chemical kidney toxicity (less radiation impact)
Solution –drilled well
Bedrock-uranium-rich granitoids and granites

17. FLUORIDE
 One of major element dry zone water
 Recommended level 1.5 mg/L
 Tropical countries 0.8 mg/L
 Dry zone some area exceed 5 mg/L
 Life time exposure 4 mg/L cause to
CKDu (NKF-US)
 Sodium-fluoride is toxic to kidney

18. FLUORIDE cont..
Fluoride distribution the
ground water SriLanka in
ppm, C.B Dissanayaka,
2005)
Distribution of fluoride in
deep well in SriLanka (C.B
Dissanayaka, 2005)
CKDu hot spot in SriLanka
(M.A.C.S. Jayasumana,
2009

19. ECO-FRIENDLY SOLUTION
1.BREADFRUIT
•Scientific name - Artocarpus altilis
•Indigenous solution -Indonesia
•Boil half matured leaves
•Drink water
2.MURUNGA
•Scientific name – Moringa oleifera
•Indigenous solution - India , Africa
•Seed cake- water purification
•Colloidal function -Bacteria and
chemical element

21. MYCOTOXIN
• Ochratoxin-A
• Fungi species Penicillium
Aspergillus
• Nephrotoxic.
• Oryza sativa and Glycine max
storage and processing
same water for soaking grains
Dry zone climate

22. HERBAL MEDICINE
• No research in SriLanka
• China and Taiwan have done
• Positive relationship with CKDu
Aristolochic acid – Renal failure
• Not popular in Dry zone SriLanka

23. ALUMINUM UTENSILS
• Commonly use
• Cheap and low quality
• Toxic compound with fluoride - (ALF x)
• Effect to the kidney

24. CYANOBACTERIAL TOCXIN

25. PHYTO-REMIDIATE PLANTS
Plants Tank eco system
Irrigation canals
Paddy fields
EX:- Nelumbo nucifera (Nelum)
Ipomoea aquatica (Kangkung)
Alternanthera triandra Lam (Mukunuwenne)

26. Considerable other factors
ARSENIC
 Recommendation - 10 µg/L (WHO)
SriLanka -100 µg/L to 200 µg/L
Ingredient - Agrochemical and pesticide
SELENIUM
 selenium - co-factor for enzymes
 Deficiency- positively impact on CKDu
NITROGEN / PHOSPHOROUS
 Nitrate recommendation - 10mg/L
 Dry zone water - 10mg/L to 30mg/L
 Phosphate level is very higher

27. Considerable Other Factors Cont..
 MAL-NUTRITION
Extreme in Dry zone
 DRUGS
 BEVERAGES
 JOB FACTOR
 GENETIC FACTOR
 UNKNOWN OTHER FACTORS

28. SUGGESTIONS
• Increase people awareness on CKDu
• Multidisciplinary research approach
• Fallow Recommendation for
Agrochemicals
• Promote mud-domestic utensils
• Promote heat water consumption
• Promote water filtering habit

30. Do what you can, with what you have, where
you are
(Theodore Roosevelt)
CKDu