chronic kidney disease in sri lanka risk factors

INTRODUCTION

Function of kidneys• Filter out waste product from

blood• Control blood pressure• Make hormones• Maintain salt and chemical in

right level

Gradual reductions of kidney functions without showing Symptoms. This kind of abnormality notice as Chronic Kidney Disease (CKDu),

First evidence 1950 Europe- Balkan region

Sri Lanka- 2000

Chronic: means ongoing ,

INTRODUCTION cont..

Major three causal factors

1) Fixed factors 2) Behavioral factors 3) Biomedical factors

INTRODUCTION cont..

Fixed factors Family history and genetic, Increasing age, Previous kidney damage, Low birth weight Male sex

INTRODUCTION cont..

Behavioral factors

Tobacco smoking, physical inactivity a poor nutrition

Biomedical factorsDiabetes High blood pressure Cardiovascular disease Over weight and obesity

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INTRODUCTION cont..

Blood test – creatinine

Glomerular Filtration Rate (GFR)

Urine analysis- Protein or red blood cells

Renal biopsy - removing a small sample of kidney tissue

DefinitionCKD is a progressive loss of renal function over a period of months or years. The symptoms of worsening kidney function are unspecific, and might include feeling generally unwell and experiencing a reduced appetite. (www.wikipedia.org/wiki/Chronic kidney disease)

WHAT IS CKDu

SRILANKAN SITUATION

Identified year 2000Last five years 6000 cases

Districts Anuradhapura Polonnaruwa Kurunegala Trincomale Ampara

CKDu hot spot in SriLanka,(Source: http://www.docstoc.com/docs)

CADMIUM

(Source: www.jamesmbrown.co.uk/cd_pigments/cdconsump.gif)

CADMIUM CONT..

Natural cadmium levels in the environment• Atmosphere 0.1 - 5 ng/m³ • Earth's crust 0.1 - 0.5 µg/g • Marine sediment ~ 1 µg/g • Sea water ~0.1 µg/l

URANIUM

No research in SriLankaPositive relationship with CKDu (RNSA-UK)Safety level 2µg/L to 30µg/L (WHO)Some Dry zone soil (U) - 3.6mg/Kg Triple Super Phosphate

chemical kidney toxicity (less radiation impact)

Solution –drilled well Bedrock-uranium-rich granitoids and granites

FLUORIDE

One of major element dry zone water

Recommended level 1.5 mg/L

Tropical countries 0.8 mg/L

Dry zone some area exceed 5 mg/L

Life time exposure 4 mg/L cause to CKDu (NKF-US)

Sodium-fluoride is toxic to kidney

FLUORIDE cont..

Fluoride distribution the ground water SriLanka in ppm, C.B Dissanayaka, 2005)

Distribution of fluoride in deep well in SriLanka (C.B Dissanayaka, 2005)

CKDu hot spot in SriLanka (M.A.C.S. Jayasumana, 2009

ECO-FRIENDLY SOLUTION

1.BREADFRUIT•Scientific name - Artocarpus altilis•Indigenous solution -Indonesia•Boil half matured leaves•Drink water

2.MURUNGA•Scientific name – Moringa oleifera•Indigenous solution - India , Africa•Seed cake- water purification•Colloidal function -Bacteria and chemical element

MYCOTOXIN

• Ochratoxin-A

• Fungi species Penicillium Aspergillus

• Nephrotoxic.

• Oryza sativa and Glycine max storage and processing same water for soaking grains Dry zone climate

HERBAL MEDICINE

• No research in SriLanka

• China and Taiwan have done

• Positive relationship with CKDu Aristolochic acid – Renal failure

• Not popular in Dry zone SriLanka

ALUMINUM UTENSILS

• Commonly use

• Cheap and low quality

• Toxic compound with fluoride - (ALF x) • Effect to the kidney

CYANOBACTERIAL TOCXIN

PHYTO-REMIDIATE PLANTS

Plants Tank eco system Irrigation canals Paddy fields

EX:- Nelumbo nucifera (Nelum) Ipomoea aquatica (Kangkung) Alternanthera triandra Lam (Mukunuwenne)

Considerable other factors

ARSENIC Recommendation - 10 µg/L (WHO)SriLanka -100 µg/L to 200 µg/LIngredient - Agrochemical and pesticide

SELENIUM selenium - co-factor for enzymes Deficiency- positively impact on CKDu

NITROGEN / PHOSPHOROUS Nitrate recommendation - 10mg/L Dry zone water - 10mg/L to 30mg/L Phosphate level is very higher

Considerable Other Factors Cont..

MAL-NUTRITION Extreme in Dry zone

DRUGS

BEVERAGES

JOB FACTOR

GENETIC FACTOR

UNKNOWN OTHER FACTORS

SUGGESTIONS

• Increase people awareness on CKDu

• Multidisciplinary research approach

• Fallow Recommendation for Agrochemicals

• Promote mud-domestic utensils

• Promote heat water consumption

• Promote water filtering habit

Do what you can, with what you have, where you are(Theodore Roosevelt)

CKDu