{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T14:29:18Z","timestamp":1784816958228,"version":"3.55.0"},"reference-count":47,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,7,9]],"date-time":"2023-07-09T00:00:00Z","timestamp":1688860800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic kidney disease of unknown cause (CKDu) is an emerging health problem in India and other countries worldwide. However, clinical descriptions, including kidney pathology, are scarce.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a descriptive case series of patients with CKDu from an endemic region in India, with a focus on clinical and biochemical characteristics, kidney biopsy findings, and environmental exposure. Patients with suspected CKDu, aged 20\u201365, and eGFR 30\u201380\u00a0mL\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup>from rural areas with endemic prevalence of CKDu were included. The exclusion criteria were diabetes mellitus, uncontrolled hypertension, proteinuria &gt;1\u00a0g\/24\u00a0h, or other known kidney diseases. The participants underwent kidney biopsies, and blood and urine samples were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fourteen participants (3 females, 11 males) with a mean eGFR of 53 (range 29\u201378) mL\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup>were included. Kidney biopsies showed a combination of chronic tubulointerstitial damage, glomerulosclerosis, and glomerular hypertrophy, with varying degrees of interstitial inflammation. Eight participants had polyuria (diuresis\u00a0\u2265\u00a03\u00a0L\/day). The urinary sediments were bland, with no haematuria. Serum potassium and sodium levels were, in most cases, normal but within the lower reference interval.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The kidney morphology and clinical characteristics in patients with CKDu in India were similar to those described for CKDu in Central America and Sri Lanka.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.13690","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T04:38:25Z","timestamp":1688445505000},"page":"492-505","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Clinical findings and kidney morphology in chronic kidney disease of unknown cause in India"],"prefix":"10.1111","volume":"294","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6183-5878","authenticated-orcid":false,"given":"Julia","family":"Wijkstr\u00f6m","sequence":"first","affiliation":[{"name":"Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumar Chakravarthy","family":"Annadata","sequence":"additional","affiliation":[{"name":"Nellore Apollo Specialty Hospitals Nellore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5114-347X","authenticated-orcid":false,"given":"Carl\u2010Gustaf","family":"Elinder","sequence":"additional","affiliation":[{"name":"Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen Kumar","family":"Kolla","sequence":"additional","affiliation":[{"name":"Narayana Medical College Nellore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narayana Rao","family":"Sarvepalli","sequence":"additional","affiliation":[{"name":"Aravind Kidney Center Nellore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneli","family":"Ring","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology and Cytology Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajendiran","family":"Swaminathan","sequence":"additional","affiliation":[{"name":"Department of Pathology Sri Ramachandra Institute of Higher Education and Research Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barathi","family":"Gunabooshanam","sequence":"additional","affiliation":[{"name":"Department of Pathology Sri Ramachandra Institute of Higher Education and Research Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"S\u00f6derberg","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Safety Sciences AstraZeneca R&amp;D Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidhya","family":"Venugopal","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Engineering, Faculty of Public Health Sri Ramachandra Institute of Higher Education and Research Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Wernerson","sequence":"additional","affiliation":[{"name":"Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1813869"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2016.04.012"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2018.10.006"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2020.1824924"},{"key":"e_1_2_9_6_1","first-page":"2066","article-title":"A newly recognized endemic region of CKD of undetermined etiology (CKDu) in South India\u2010\u201cTondaimandalam Nephropathy\u201d","volume":"5","author":"Parameswaran S","year":"2020","journal-title":"Kidney Int."},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"253","DOI":"10.4103\/ijn.IJN_363_18","article-title":"Pathology of Uddanam endemic nephropathy","volume":"30","author":"Gowrishankar S","year":"2020","journal-title":"Indian J Nephrol."},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2020.10.007"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.05.019"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2016.10.036"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0193056"},{"key":"e_1_2_9_12_1","unstructured":"CroweJL JoubertBR BrooksDR editors.Report from the Third International Workshop on chronic kidney diseases of uncertain\/non\u2010traditional etiology in Mesoamerica and other regions.Heredia Costa Rica:SALTRA;2020. Available at:https:\/\/www.niehs.nih.gov\/news\/assets\/docs_a_e\/ckdu_report_508.pdf."},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002366"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1114248"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.11.009"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.37757\/MR2014.V16.N2.8"},{"key":"e_1_2_9_18_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-023353","article-title":"Prevalence of and risk factors for chronic kidney disease of unknown aetiology in India: secondary data analysis of three population\u2010based cross\u2010sectional studies","volume":"9","author":"O'callaghan\u2010Gordo C","year":"2019","journal-title":"BMJ Open."},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2017.09.012"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-6-201303190-00006"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.04.057"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2022.12.022"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.37757\/MR2014.V16.N2.7"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00259.2019"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2015.07.007"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2020-106406"},{"key":"e_1_2_9_27_1","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1136\/oemed-2021-107989","article-title":"Markers of kidney tubular and interstitial injury and function among sugarcane workers with cross\u2010harvest serum creatinine elevation","volume":"79","author":"Hansson E","year":"2022","journal-title":"Occup Environ Med."},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfab258"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.26633\/RPSP.2020.15"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2021.100101"},{"key":"e_1_2_9_31_1","first-page":"277","article-title":"The effects of heatstroke on the function and structure of the kidney","volume":"36","author":"Kew MC","year":"1967","journal-title":"Q J Med."},{"key":"e_1_2_9_32_1","first-page":"189","article-title":"Chronic interstitial nephritis as a consequence of heatstroke","volume":"39","author":"Kew MC","year":"1970","journal-title":"Q J Med."},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0235607"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-020-01804-x"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2013.492"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00495.2016"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2021.07.031"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chemosphere.2017.02.155"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00021.2022"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.16831221"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfy070"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1539\/joh.13-0172-OA"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12199-015-0475-1"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2005020172"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-021-02988-3"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.3961\/jpmph.16.087"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.4038\/cmj.v65i1-2.9132"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-020-01026-2"}],"container-title":["Journal of Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/joim.13690","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T15:54:25Z","timestamp":1729698865000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/joim.13690"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,9]]},"references-count":47,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1111\/joim.13690"],"URL":"https:\/\/doi.org\/10.1111\/joim.13690","archive":["Portico"],"relation":{},"ISSN":["0954-6820","1365-2796"],"issn-type":[{"value":"0954-6820","type":"print"},{"value":"1365-2796","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,9]]},"assertion":[{"value":"2023-07-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}