JUser: :_load: Unable to load user with ID: 291

Thursday, 19 May 2016 12:41

Clinical Research: CKD of unknown origin (CKDu) – is it the same disease in Central America and in Asia? A comparison of renal histopathology - and biochemical findings in patients with CKDu

Rate this item
(1 Vote)

image leivaName: Ricardo Leiva  coworkers : Marvin Gonzalez, Channa Jayasumana, Annika Wernerson

Hospital / Affiliation: Cordinating institution: Hospital Nacional Rosales, San Salvador, El Salvador

Home Country: El Salvador

Year: 2013

Status of your program: IN PROGRESS




Title of the project: 

Chronic Kidney Disease of unknown origin (CKDu) :Is it the same disease in Central America and in Asia?
A comparison of renal histopathology - and biochemical findings in patients with CKDu 


Chronic kidney Disease, Pathology


Short description of the project or abstract:

During the last decades, several rural regions in Central America have seen a dramatic increase of a chronic kidney disease of unknown etiology, unexplained by conventional risk factors like diabetes and hypertension (CKDu). El Salvador and Nicaragua have the highest death rates due to kidney disease worldwide according to WHO. CKDu often affects young and middle-aged male laborers in the agricultural sector, in particular sugarcane workers. The leading hypothesis is that occupational heat stress with repeated dehydration/volume depletion causes the kidney damage.
However, this hypothesis has not yet been definitely proven. An increased prevalence of CKDu has also been reported from the rural North Central province of Sri Lanka, where the disease often affects agricultural workers engaged in rice cultivation. There are also limited reports from rural regions in India. The distinct geographical and socioeconomic disease patterns suggest that environmental and occupational factors may have an important role as causative agents.

The increase in CKDu in certain regions in Central America and Sri Lanka is overwhelming the healthcare systems and also has a profound negative effect on vulnerable poor rural communities. It is of great importance to understand the disease and its mechanisms in order to develop primary and secondary prevention programs. To study the renal morphology in kidney biopsies gives important knowledge about possible pathophysiological mechanisms. Biopsy studies from El Salvador report a unique renal morphology with damage to both glomerular and interstitial compartments. Studies from Sri Lanka report a tubulointerstitial disease with glomerular damage. However, a direct comparison of the biopsy studies is not possible due to differences in included participants. Thus, as of yet, it is not established that the CKDu in Central America and Sri Lanka are similar diseases.

The general aim of this study is to explore whether the CKDu observed in Central America and Asia are similar diseases – an important step into elucidation of the etiology(ies).
This will be accomplished by meetings, assembly of well-characterized biopsies from cohorts of CKDu patients from El Salvador, Nicaragua and Sri Lanka, and a workshop at Karolinska Institutet, Sweden, for pathologists from each participating country where biopsies are scrutinized, followed by collaborative scientific evaluation.

Progress: As of today the cohorts from El Salvador and Nicaragua has been described in detail and the study of CKDu patients from Sri Lanka will take place in May 2016. Collaborating researchers and nephrologists has been identified in India. When the Sri Lanka biopsy study has been performed and analysed, planning for the joint workshop on the renal morphology will start.


Learning or Research objectives:

  • To compare the renal morphology and biochemical findings in well characterized cohorts of patients from El Salvador, Nicaragua, Sri Lanka, and possibly also other countries with CKDu
  • To develop and implement a scheme for histopathological changes and diagnostic criteria, that can be used for both clinical documentation and future collaborative studies
  • To create a network of pathologists with a special interest in renal pathology to strengthen the local capacity in each participating center


Additional Info

  • Year: 2013
  • Status: In progress
  • Partners: ISN only
  • Region: Latin America and the Caribbean
  • Country: El Salvador
  • Topics: CKD, Pathology
Read 7775 times Last modified on Friday, 17 February 2017 12:25

Global Operations Center

Avenue des Arts 1-2
1210 Brussels, Belgium
Tel: +32 2 808 04 20
Fax: +32 2 808 4454
Email contact


Americas Operations Center

340 North Avenue 3rd Floor
Cranford, NJ 07016-2496, United States
Tel: +1 567 248 9703
Fax: +1 908 272 7101
Email contact