BMC nephrology · 2025
Lack of evidence for viral etiology in symptomatic chronic kidney disease of unknown etiology (CKDu) in Sri Lanka.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Pushpakumara Nilantha, Freund Paul, Premarathne Shakila, Hewavitharane Pasan, Erandika Naduni, Herath Dulanjali, Weerakoon Thilini, Wijethunga Sulochana, Ratnatunga Neelakanthi, Wazil Abdul, Skopnik Christopher M, Metzke Diana, Melchert Julia, Bleicker Tobias, Amman Kerstin, Daniel Christoph, Corman Victor M, Jones Terry C, Weiss Sabrina, Eckardt Kai-Uwe, Enghard Philipp, Nanayakkara Nishantha
Аннотация
BACKGROUND: Chronic kidney disease of unknown etiology (CKDu) is a major health problem in Sri Lanka. A transient symptomatic episode, characterized by fever, dysuria, and arthralgias, accompanied by kidney dysfunction, has been reported in endemic areas of CKDu. Sym-CKDu has shown with histological features consistent with acute interstitial nephritis and is considered a potential initiating event of CKDu. Among various potential etiologies, viral infections such as Hantavirus, Cytomegalovirus (CMV), and Epstein-Barr virus (EBV) have been implicated in the causation of CKDu.
METHODS: Here, we performed a prospective observational cohort study of symptomatic patients presenting with at least three of symptoms - i.e. arthralgia, myalgia, fever, back pain or feeling unwell an outpatient clinic in a CKDu-endemic region of Sri Lanka. Between June 2018 and November 2021, a cohort of 151 patients presenting with a feverish syndrome to an outpatient clinic in a CKDu endemic region in Sri Lanka were included in this study, and 85 patients returned for follow-up. serum creatinine, CRP, cystatin C and dipstick proteinuria were determined. Serum samples (n = 32) were screened for antibodies against known human pathogenic viruses using the VirScanTM-Pipeline. Kidney biopsies (n = 19) were analyzed for the presence of viral pathogens using a PAN-Hanta-PCR and next-generation sequencing (NGS).
RESULTS: The prevalence of reduced eGFR at initial presentation was high, especially in men. After a median follow-up of 2.3 years, 16 patients had lost ≥ 4 ml/min/1.73m2 eGFR per year and their eGFR was < 90 ml/min/1.73m2 at the last follow-up. Patients who experienced a loss of eGFR clustered geographically. Virome screening did not identify any antibody reactivity in the group with loss of eGFR. NGS evaluation and Hanta-PCR of 19 kidneys biopsies did not detect viral pathogens.
CONCLUSION: A significant proportion of patients in a CKDu endemic region presenting with a feverish syndrome developed a substantial loss of eGFR over the following years. No evidence of a viral etiology was found.
TRIAL REGISTRATION: Not applicable.
METHODS: Here, we performed a prospective observational cohort study of symptomatic patients presenting with at least three of symptoms - i.e. arthralgia, myalgia, fever, back pain or feeling unwell an outpatient clinic in a CKDu-endemic region of Sri Lanka. Between June 2018 and November 2021, a cohort of 151 patients presenting with a feverish syndrome to an outpatient clinic in a CKDu endemic region in Sri Lanka were included in this study, and 85 patients returned for follow-up. serum creatinine, CRP, cystatin C and dipstick proteinuria were determined. Serum samples (n = 32) were screened for antibodies against known human pathogenic viruses using the VirScanTM-Pipeline. Kidney biopsies (n = 19) were analyzed for the presence of viral pathogens using a PAN-Hanta-PCR and next-generation sequencing (NGS).
RESULTS: The prevalence of reduced eGFR at initial presentation was high, especially in men. After a median follow-up of 2.3 years, 16 patients had lost ≥ 4 ml/min/1.73m2 eGFR per year and their eGFR was < 90 ml/min/1.73m2 at the last follow-up. Patients who experienced a loss of eGFR clustered geographically. Virome screening did not identify any antibody reactivity in the group with loss of eGFR. NGS evaluation and Hanta-PCR of 19 kidneys biopsies did not detect viral pathogens.
CONCLUSION: A significant proportion of patients in a CKDu endemic region presenting with a feverish syndrome developed a substantial loss of eGFR over the following years. No evidence of a viral etiology was found.
TRIAL REGISTRATION: Not applicable.