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2018 ; 19
(1
): 115
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Early renal damage among children living in the region of highest burden of
chronic kidney disease of unknown etiology (CKDu) in Sri Lanka
#MMPMID29769043
BMC Nephrol
2018[May]; 19
(1
): 115
PMID29769043
show ga
BACKGROUND: Chronic kidney disease of unknown origin (CKDu) in Sri Lanka is
grouped with several other epidemics of similar nature across the world as
Chronic Interstitial Nephritis in Agricultural Communities (CINAC). In CKDu
endemic countries, the focus has mainly been on adults. We hypothesized that
studying distribution and factors associated with elevated urine albumin to
creatinine ratio (UACR), an early marker of kidney injury, among children living
in a CKDu endemic area may provide important clues about the onset and
progression of the disease. METHODS: This cross sectional study was performed in
rural primary schools in North Central Province of Sri Lnaka, a CKDu high endemic
region. Total of 2880 students aging 5 to 11 years from 67 schools were enrolled
for urinalysis in a random spot urine sample. Bedside Schwartz formula was used
to measure estimated glomerular filtration rate (eGFR) on all children with UACR
>?30 mg/g in Polonnaruwa district and a group of age matched controls. A standard
multiple linear regression using log transformed UACR as the dependent variable
was performed. Mean eGFR were compared between UACR elevated group and controls
using independent sample t test. RESULTS: Median UACR was 10.3 mg/g. Sex,
ethnicity, history of having a chronic disease and age uniquely contributed to
the multiple regression model which only explained 2.8% of the variance in the
log of the UACR (p 0.001). Only 15 (0.5%) had UACR>?300 mg/g while 8.2%
(n =?236) had UACR between 30 to 300 mg/g and 89.8% (n =?203) of them did not
have a chronic disease (Chi square 2.21, p =?0.091). Mean eGFR was significantly
lower in the group with elevated UACR (88.9 mg/dl/1.73 m2, 95% CI for mean 86.4-
91.3) compared to group with normal UACR (93.7 mg/dl/1.73 m2,95% CI 91.1- 96.3)
(t 2.7, p 0.007). Three out of the four students with eGFR less than
60 mg/dl/1.73 m2 had moderately elevated UACR. CONCLUSION: This study provides
evidence to suggest that children in CKDu endemic regions are having an early
renal damage. This observation needs to be investigated further in order to
understand the worldwide epidemic of CKDu.