title: Endemic Nephropathy Around the World.
abstract: There have been several global epidemics of chronic kidney disease of unknown etiology (CKDu). Some, such as Itai-Itai disease in Japan and Balkan endemic nephropathy, have been explained, whereas the etiology of others remains unclear. In countries such as Sri Lanka, El Salvador, Nicaragua, and India, CKDuis a major public health problem and causes significant morbidity and mortality. Despite their geographical separation, however, there are striking similarities between these endemic nephropathies. Young male agricultural workers who perform strenuous labor in extreme conditions are the worst affected. Patients remain asymptomatic until end-stage renal failure. Biomarkers of tubular injury are raised, and kidney biopsy shows chronic interstitial nephritis with associated tubular atrophy. In many of these places access to dialysis and transplantation is limited, leaving few treatment options. In this review we briefly describe the major historic endemic nephropathies. We then summarize the epidemiology, clinical features, histology and clinical course of CKDuin Mesoamerica, Sri Lanka, India, Egypt, and Tunisia. We draw comparisons between the proposed etiologies and supporting research. Recognition of the similarities may reinforce the international drive to establish causality and to effect prevention.
authors.affiliation: Pharmacology, Toxicology & Therapeutics, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Fiona J
authors.initials: FJ
authors.lastname: Gifford
authors.affiliation: Pharmacology, Toxicology & Therapeutics, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Gifford
authors.affiliation: Pharmacology, Toxicology & Therapeutics, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Michael
authors.initials: M
authors.lastname: Eddleston
authors.affiliation: Pharmacology, Toxicology & Therapeutics, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Dhaun
keywords: CKDu; chronic kidney disease; endemic nephropathy