This Presentation On CkDu Chronical Kidney Disease of Unknown Eitiology

2. Chronic Kidney Disease of
Unknown Etiology (CKDu)
Group No 5 - Water Science and Technology
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4. Affected areas
in srilanka
• Girandurukotte in
Badulla District
• Medawachchiya and
Padaviya in
Anuradhapura
District
• Medirigiriya and
Hingurakgoda in
Polonnaruwa District
• Nickawewa in
Kurunagala District
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5. FACTS ABOUT CKDu IN SRI LANKA
• Affected patients are mostly rice paddy farmers.
• According to the Ministry of Health, the estimated
number of CKDu cases is 69,258 as of June 2014
• Estimated death toll is 20,000
• Affected patients were of age categories over 55 years
• The age category is shifting towards younger ages
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6. Common Chronic Kidney
Disease (CKD)
Who get it ?
Older people, male & female
Risk Factors
• Diabetes
• Hypertension
• Obesity
Proteins in urine
high
Chronic Kidney Disease of
Unknown Etiology (CKDu)
Who get it ?
Working age male
Risk Factors
• No Glomerulonephritis
• No Diabetes mellitus
• No Hypertension
Proteins in urine
low
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7. What is CKDu ?
Any condition that causes reduced
kidney function over a period of time
is a chronic kidney disease.
• The causative factors and etiology
of this chronic kidney disease is still
considered uncertain or unknown
and abbreviated as CKDu
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8. Factors affect for CKDu
Environmental factors
• Excessive cadmium or
Arsenic
• High Fluoride in Ground
water
• Cyanobacterial toxins in
water
• Bio accumulation of
pesticides residue
• Aluminum Utensils +
Fluoride water
• Naturally occurring hard
water
Life-style factors
• Locally brewed liquor
• Ayurveda medicinal
concoctions
Genetic predisposition
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9. Effect of Fluoride to CKDu
• Fluoride or fluoroaluminate complexes being directly
responsible for CKDu .
• fluorosis prohibits the detoxification mechanism of bones.
• Therefore, patients with fluorosis are more prone to get
their kidneys damaged by other toxic chemicals such as
cadmium and arsenide ions.
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10. • Fluoride incorporated into the hydroxyapatite
[Ca10(PO4)6(OH)2] lattice through ion-exchange.
Ca10(PO4)6(OH)2(s) + xF-
(Porous) (Blood)
⇌
Ca10(PO4)6(OH)2-xFx(s) + xOH-
(Denser) (Blood)
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11. DENTAL AND SKELETAL FLUOROSIS
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12. Effect of Bio Accumulation of
pesticides to CKDu
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13. 13

14. After the ingestion, cadmium is transported to
the liver where it stimulates the synthesis of
metallothionein.
Cadmium is then bound to metallothionein
and transported via blood to kidneys
Complexes break and cadmium ions bind to
newly formed metallothionein in the tubular
cells.
Kidney damage takes place when the kidney
no longer produces metallothionein
increased excretion of specific proteins in the
urine.
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15. • The kidney is the major target organ of cadmium.
• The critical concentration for toxic effects appears to be
between 200 and 250 µg/g of kidney tissue (200-250 ppm)
[31]
• When the renal tubular cells become saturated with
cadmium (because the storage capacity of metallothionein
is exceeded) free cadmium is released.
• It is widely believed that this free cadmium ion is the
cause of the renal damage.
• Free cadmium ions may replace zinc in some systems,
especially those enzymes involved in the reabsorption and
catabolism of proteins. 15

16. Effect of Arsenic to CKDu
• Binding of Ca3(AsO4)2 to Arsenic transporters
in the liver and transport to the kidney.
•Deposition of Ca3(AsO4)2 crystals in the kidney
tissues.
•Release of Arsenate groups
•This is an ionic compound release should depend on
water solubility.
•This COMPOUND is NOT WATER SOLUABLE. 16

17. Effect of cyanobacterial toxin to
CKDu
• identified 15 toxin producible cyanobacteria in
our reservoirs and canals.
• Toxin producible cyanobacteria in our
reservoirs and canals of affected regions
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18. What are the symptoms of CKDu?
feel more tired and have less energy
have trouble concentrating
have a poor appetite
have trouble sleeping
have muscle cramping at night
have swollen feet and ankles
have puffiness around your eyes, especially in the
morning
have dry, itchy skin
need to urinate more often, especially at night.
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19. To identify if we may have chronic kidney
disease?
 Calculate your Glomerular Filtration Rate (GFR)
when a patient’s glomerular filtration rate remains below 60
mL min-1 for more than 3 months
when a patient’s urine albumin-to-creatinine ratio is over 30
mg of albumin for each g of creatinine (30 mg g-1).
 Perform an ultrasound or CT scan to get a picture of your
kidneys and urinary tract.
 Perform a kidney biopsy
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20. SUGGESTIONS
• Increase people awareness on CKDu
• Follow recommendation for Agrochemicals
• Promote heat water consumption
• Promote water filtering habit
• Promote clay domestic utensils
• Multidisciplinary research approach
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21. References
 http://bmcnephrol.biomedcentral.com/
 http://nas-srilanka.org/
 CKDu REVISITED – Peradeniya University
 http://www.brighthub.com/
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22. Group No 5
• Kalansooriya ND UWU/MRT/13/0013
• Kanagarajah K UWU/MRT/13/0015
• Virgin Mary Reva K UWU/MRT/13/0016
• Kularatne KAM UWU/MRT/13/0017
• Kumara AMIU UWU/MRT/13/0019
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