{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:29:45Z","timestamp":1790364585859,"version":"4.1.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>A kidney disease of unknown cause is common in Sri Lanka\u2019s lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>We designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics\u2014age, urine dipstick for protein, and serum albumin\u2014could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.07430618","type":"journal-article","created":{"date-parts":[[2019,1,18]],"date-time":"2019-01-18T16:55:10Z","timestamp":1547830510000},"page":"224-232","source":"Crossref","is-referenced-by-count":39,"title":["Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka"],"prefix":"10.2215","volume":"14","author":[{"given":"Shuchi","family":"Anand","sequence":"first","affiliation":[{"name":"Division of Nephrology and Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria E.","family":"Montez-Rath","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinuka","family":"Adasooriya","sequence":"additional","affiliation":[{"name":"Kandy Teaching Hospital, Kandy, Sri Lanka;"},{"name":"Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neelakanthi","family":"Ratnatunga","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Peradeniya, Kandy, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeraja","family":"Kambham","sequence":"additional","affiliation":[{"name":"Pathology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdool","family":"Wazil","sequence":"additional","affiliation":[{"name":"Kandy Teaching Hospital, Kandy, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulcohana","family":"Wijetunge","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Peradeniya, Kandy, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeid","family":"Badurdeen","sequence":"additional","affiliation":[{"name":"Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charaka","family":"Ratnayake","sequence":"additional","affiliation":[{"name":"Kandy Teaching Hospital, Kandy, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishamani","family":"Karunasena","sequence":"additional","affiliation":[{"name":"Kandy Teaching Hospital, Kandy, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen L.","family":"Schensul","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Health Care and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penny","family":"Valhos","sequence":"additional","affiliation":[{"name":"Department of Marine Sciences, University of Connecticut, Groton, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lalarukh","family":"Haider","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of Connecticut Health Center, Farmington, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Bhalla","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeera","family":"Levin","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul H.","family":"Wise","sequence":"additional","affiliation":[{"name":"Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn M.","family":"Chertow","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Barry","sequence":"additional","affiliation":[{"name":"Medicine, Stanford University School of Medicine, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew Z.","family":"Fire","sequence":"additional","affiliation":[{"name":"Pathology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishantha","family":"Nanayakkara","sequence":"additional","affiliation":[{"name":"Kandy Teaching Hospital, Kandy, Sri Lanka;"},{"name":"Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,1,18]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1038\/ki.2011.258","article-title":"Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka.","volume":"80","author":"Athuraliya","year":"2011","journal-title":"Kidney Int"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s12199-011-0243-9","article-title":"Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka.","volume":"17","author":"Nanayakkara","year":"2012","journal-title":"Environ Health Prev Med"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1539\/joh.13-0172-OA","article-title":"An integrative study of the genetic, social and environmental determinants of chronic kidney disease characterized by tubulointerstitial damages in the North Central Region of Sri Lanka.","volume":"56","author":"Nanayakkara","year":"2014","journal-title":"J Occup Health"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1053\/j.ajkd.2011.11.039","article-title":"Decreased kidney function among agricultural workers in El Salvador.","volume":"59","author":"Peraza","year":"2012","journal-title":"Am J Kidney Dis"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1053\/j.ajkd.2009.12.012","article-title":"Decreased kidney function of unknown cause in Nicaragua: A community-based survey.","volume":"55","author":"Torres","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"B8-20230813","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1590\/S1020-49892002000900009","article-title":"[End-stage renal disease among patients in a referral hospital in El 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Padavi-Sripura, Sri Lanka.","volume":"14","author":"Jayasumana","year":"2015","journal-title":"Environ Health"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/j.trstmh.2007.05.006","article-title":"Chronic renal failure in North Central Province of Sri Lanka: An environmentally induced disease.","volume":"101","author":"Wanigasuriya","year":"2007","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s10653-010-9339-1","article-title":"Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: Geographic distribution and environmental implications.","volume":"33","author":"Chandrajith","year":"2011","journal-title":"Environ Geochem Health"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified poisson regression approach to prospective studies with binary 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Guatemala.","volume":"60","author":"Butler-Dawson","year":"2018","journal-title":"J Occup Environ Med"},{"key":"B31-20230813","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/j.envres.2015.07.007","article-title":"Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador\u2013A cross-shift study of workers at risk of Mesoamerican nephropathy.","volume":"142","author":"Garc\u00eda-Trabanino","year":"2015","journal-title":"Environ Res"},{"key":"B32-20230813","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1179\/2049396714Y.0000000102","article-title":"Changes in kidney function among Nicaraguan sugarcane workers.","volume":"21","author":"Laws","year":"2015","journal-title":"Int J Occup Environ Health"},{"key":"B33-20230813","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1053\/j.ajkd.2016.06.012","article-title":"Characterization of Mesoamerican nephropathy in a kidney failure hotspot in Nicaragua.","volume":"68","author":"Kupferman","year":"2016","journal-title":"Am J Kidney Dis"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201902000-00011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:38:15Z","timestamp":1786369095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201902000-00011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,18]]},"references-count":27,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.07430618","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1,18]]}}}