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

  • Shanika Nanayakkara
  • Toshiyuki Komiya
  • Neelakanthi Ratnatunga
  • S. T. M. L. D. Senevirathna
  • Kouji H. Harada
  • Toshiaki Hitomi
  • Glenda Gobe
  • Eri Muso
  • Tilak Abeysekera
  • Akio Koizumi
Regular Article


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 mortality among young farmers. Although cadmium has been suspected as a causative pathogen, there have been controversies. To date, the pathological characteristics of the disease have not been reported. Histopathological observations of 64 renal biopsies obtained at Anuradhapura General Hospital from October 2008 to July 2009 were scored according 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 atrophy with or without nonspecific interstitial mononuclear cell infiltration was the dominant histopathological observation. 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 common clinical features among the cases, it did not influence the histopathological lesions in all the cases. This study concludes that tubulointerstitial damage is the major pathological lesion in CKDu. Exposure(s) to an environmental pathogen(s) should be systematically investigated to elucidate such tubulointerstitial damage in CKDu.


Chronic kidney disease Farmers Cadmium Histopathology Sri Lanka 

Supplementary material

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Supplementary material 1 (DOC 42.5 kb)


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Copyright information

© The Japanese Society for Hygiene 2011

Authors and Affiliations

  • Shanika Nanayakkara
    • 1
  • Toshiyuki Komiya
    • 2
  • Neelakanthi Ratnatunga
    • 3
  • S. T. M. L. D. Senevirathna
    • 1
  • Kouji H. Harada
    • 1
  • Toshiaki Hitomi
    • 1
  • Glenda Gobe
    • 4
  • Eri Muso
    • 2
  • Tilak Abeysekera
    • 5
  • Akio Koizumi
    • 1
  1. 1.Department of Health and Environmental SciencesKyoto University Graduate School of MedicineKyotoJapan
  2. 2.Department of Nephrology and DialysisTazuke Kofukai Medical Research Institute Kitano HospitalOsakaJapan
  3. 3.Department of Pathology, Faculty of MedicineUniversity of PeradeniyaPeradeniyaSri Lanka
  4. 4.Department of Molecular and Cellular Pathology, School of Medicine, Princess Alexandra HospitalUniversity of QueenslandBrisbaneAustralia
  5. 5.Nephrology UnitGeneral Hospital (Teaching)KandySri Lanka

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