Research Viewpoints Chronic Kidney Disease of Undetermined Etiology: A Review

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Floris M, Lepori N, Angioi A, Cabiddu G, Piras D, Loi V, Swaminathan S, Rosner M, Pani A: Chronic Kidney Disease of Undetermined Etiology around the World. Kidney and Blood Pressure Research DOI 10.1159/000513014

Chronic kidney disease of undetermined etiology (CKDu) is endemic in several parts of the world, especially among agricultural workers exposed to high ambient temperatures, episodic dehydration, and uric acid-crystalluria and nephrotoxins (such as agricultural pesticides). The “disease” is very likely heterogeneous in etiology. Whether it can be positively defined by its pathological features is controversial, but alterations seen in mitochondria by electron microscopy suggest a nephrotoxic basis in many cases. The dominant picture is a chronic, progressive tubule-interstitial nephritis. It is a common cause of kidney failure in the affected regions.

Floris and colleagues from Sardinia and the USA provide a very well-written, comprehensive and up-to-date review of the epidemiology, ethnography, susceptibility (genetic and environmental), possible causes/pathogenesis, clinical and histologic features, pathways for prevention, and needed further research. They advance a hypothesis that CKDu is caused by an interaction between geography-specific risk factors and the influence of protective factors. The clustering of cases in Mexico, Meso-America, Tunisia, Egypt, Uddanam (India), and Sri Lanka strongly suggest an environmental cause (– heat, dehydration, pesticides?) which may vary from country to country. The review is worth reading for those who want to learn more about this intriguing “disease.”