In 2016, the Uddanam region of Andhra Pradesh reported many cases of chronic kidney disease of unknown origin. Kidney function was decreased in these cases, but with minimal urinary findings. Moreover, the patients did not have traditional risk factors, such as hypertension, diabetes mellitus, or obesity. The condition was called Uddanam nephropathy.
Cases of chronic kidney disease of unknown origin were later reported from parts of Tamil Nadu and Puducherry. Similar cases are reported from parts of South America and Sri Lanka as well. However, there is a lack of studies on the clinical pictures, biochemical findings, and renal biopsy morphologies of patients with chronic kidney disease of unknown origin in India.
So researchers from Nellore and Chennai collaborated with colleagues in Sweden to provide a detailed description of kidney morphology and biochemical findings in a case series of such patients from rural Andhra Pradesh.
From hospitals in Nellore, they took case studies of nephropathy. Excluding those with diabetes mellitus, uncontrolled hypertension, high proteinuria or other known or clinically diagnosed kidney diseases, there were 11 males and 3 females aged twenty to sixty-five in the cohort.
The researchers collected blood and urine samples from the patients. Eight participants had excessive urine – more than 3 litres per day. There were no sediments or blood in the urine. Serum potassium and sodium levels were mostly normal but within the lower reference interval.
With the help of percutaneous ultrasound, a method to visualise the inserted needle, the researchers collected small kidney samples from the patients. They evaluated the kidney biopsy cores using light microscopy, immunofluorescence, and transmission electron microscopy. The biopsies showed damage to kidney tubules and surrounding tissues. The glomeruli, the filtration units of the kidney, were enlarged and harder than normal to various degrees. The tissues around the glomeruli were inflamed.
The kidney morphology and clinical characteristics of patients with chronic kidney disease in India were similar to those described for the disease in Central America and Sri Lanka.
Using a questionnaire, the researchers collected the medical history of the 14 patients as well as data on occupation and environmental exposures. Correlations with kidney damage and occupational exposures suggest exposure to hot and humid environments as possible reasons for chronic kidney disease of unknown cause.
“Providing water, rest and shade may decrease the risk of kidney injury”, says Rajendiran Swaminathan, Sri Ramachandra Institute of Higher Education and Research, Chennai.
Journal of Internal Medicine, 0; 1–14 (2023);
DOI: 10.1111/joim.13690
Reported by M. Karunanithi
SASTRA Deemed University, Thanjavur
*This report was written during the 4th online workshop on science writing organised by Current Science.
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