Thursday, 23 November 2017 11:22

Clinical Research: Screening of CINAC Among Adolescents

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Name: Channa Jayasumana

Hospital/Affiliation: University of Sri Lanka

Home Country: Sri Lanka

Year: 2017

Status of the program: ONGOING


Title of the project:

Screening of CINAC Among Adolescents


CKD, Pathology

Short description of the project or abstract: Since early the 1990s, an increase in CKD prevalence related to non-traditional risk factors primarily affecting agricultural communities and male agricultural workers has been reported in several tropical countries. Histopathological characteristics consist in a tubule-interstitial disease with glomerular (sclerosis) involvement. Considering demographic, clinical and histopathological findings disease is named as chronic interstitial nephritis among agricultural communities (CINAC).  

We hypothesized that initial kidney damage may begin in childhood prior to entering the workforce. However, rise in serum creatinine is a relatively late finding in the development of CINAC, we used novel biomarkers of early kidney damage as the primary measure of outcome.
Protein measurement in urine has been used for many years for diagnosing and monitoring of diseases. The pattern of urinary protein excretion can be used to diagnose and monitor renal injuries at particular sites within the nephron.  In the present study a series of urinary proteins/enzymes will be measured that may be indicative for the presence of a particular renal pathology.  In a next stage of the study, in patients showing a positive urinary protein excretion, a proteomics analysis will be performed in a renal biopsy which in turn may provide further mechanistic insight in the pathology and potentially provide new, more specific early markers of CINAC.

A cross-sectional study will be conducted among school children aged 15-16 years in different schools at 5 locations in Sri Lanka. Medawachchiya, Padavi Sripura and Medirigiriya are CINAC endemic areas. Colombo and Mannar are CINAC non-endemic areas. Children in Colombo and Mannar will be considered as negative controls. Mannar is the hottest area in Sri Lanka. By selecting Mannar we may assess the effect of heat stress and dehydration  on the concentration of urinary biomarkers in school children. 20 positive controls with renal biopsy compatible with CINAC will also be included.

Renal markers indicative of damage of primarily glomerular, tubular or both will be measured in mid-stream morning urine. All children will undergo a second screening 4 months later. Only the children who present with increased urinary markers at both screenings will undergo a third screening 4 months later Renal biopsy will be performed in subjects in whom the same two markers were positive in two out of three screenings For histological and proteomic analysis of the renal biopsy. In these subjects urinary proteomics will be performed also. 50 school children (25 boys/25 girls) will be recruited at grade 10 classes from the various places. So there will be 250 participants in total for the study; 125 boys and 125 girls. The sealed envelope method will be used for randomization. Questionnaires will be completed by an experienced interviewer to collect demographical data as well as to evaluate the possible exposure to agrochemicals. A series of (early) markers of renal injury will be measured in a first urine fraction at the University of Antwerp.

Learning or research objectives:
Hypothesis: Glomerular or tubular, lesions in CINAC begin in childhood. Nephron segment specific markers of early
renal damage are present at abnormal concentration in urine samples of school children living in CINAC
endemic areas.
Aim: To assess the presence and type of early sub-clinical kidney damage in CINAC endemic areas

Additional Info

  • Year: 2017
  • Status: In progress
  • Partners: APSN
  • Region: South Asia
  • Country: Sri Lanka
  • Topics: CKD, Pathology
Read 7648 times Last modified on Thursday, 23 November 2017 11:46

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