Chronic Kidney Disease of Unknown Origin in Sri Lanka: A Literature Review

Abstract

Sri Lanka is a tropical island situated south of India. A rise of incidence of chronic kidney disease (CKD) was reported from the dry zone of the country in the 1990s, which was not attributed to the traditional causes of CKD. It was named as chronic kidney disease of unknown origin (CKDu). We reviewed the literature to summarize the existing information on CKDu in Sri Lanka. The disease is more prevalent among farmers and has a unique locality. Numerous nephrotoxins, irrigation networks, genetic susceptibility, soil factor, and even bioterrorism as possible etiologies have been considered. Drinking water was proven to be hard and contain high fluoride levels, but toxins in food and water were controversial. Urine and tissues of affected patients contained some of the suspected toxins at higher levels. Though the majority of the researchers agreed on a toxic nephropathy, none of their hypotheses explain the clinical findings, and the unique locality of the disease, and its appearance in the 1990s. The absence of an identifiable cause has hampered controlling the disease. Careful use of agrochemicals and more researches to unravel the mystery is recommended.