Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka

Chronic kidney disease of uncertain etiology (CKDu) in North Central Province of Sri Lanka has become a key public health concern in the agricultural sector due to the dramatic rise in its prevalence and mor-tality among young farmers. Although cadmium has been suspected as a causative pathogen, there have been con-troversies. To date, the pathological characteristics of the disease have not been reported. Histopathological obser-vations of 64 renal biopsies obtained at Anuradhapura General Hospital from October 2008 to July 2009 were scored ccording to Banff 97 Working Classification of Renal Allograft pathology. The correlations between the histological observations and clinical parameters were
statistically analyzed. Interstitial fibrosis and tubular atro-phy with or without nonspecific interstitial mononuclear cell infiltration was the dominant histopathological obser-vation. Glomerular sclerosis, glomerular collapse, and
features of vascular pathology such as fibrous intimal thickening and arteriolar hyalinosis were also common. Although hypertension was identified as one of the com-mon clinical features among the cases, it did not influence the istopathological lesions in all the cases. This study concludes that bulointerstitial damage is the major pathological lesion in CKDu. Exposure(s) to an environ-ental pathogen(s) should be systematically investigated to elucidate such ubulointerstitial damage in CKDu