Are there any molecular markers for heavy metal toxicity ?
There are multiple reasons eg: use of melamine, lead poisoning, long term use of medicines, long term use of minirals or mercury compounds, loss of cortical thickness, long term renal infections etc
Morphology of the kidney (Echography). Bilateral renal artery stenosis. .Proteinuria.Monoclonal gammopathy. Myeloma
Obstruction (Urinary).Urinalysis.
Thousands of people in NCP in Sri Lanka affecing and dying due to a CRF of unknown etiology. Most affected are farmers and living more than 10 years in the region and are often younger and no history. Diabetes and Hypertension previously.
To date no evidence of immunological involvement found. However some suggest Arsenic and cadmium toxicity from agrochemicals. genetic succeptibilty is being tested.
http://www.biomedcentral.com/1471-2369/12/32
Actually the htn, dm type 2, are not definite cause of crf, these are signs. Dm is recognized as metabolic syndrome. Which developed due to some disorder or disease(s), and htn commonly developed when the na retained in body or when the water retains and this is true that most of the crf cases are suffered from dm or htn or both. The of crf is some where else in the body. My be fibrosis, infection etc.
The search for etiology always has to start with a good and extensive history (anamnesis) to be taken eventually in repeated talks with the patient. Mostly in a rural area, I would favor Aristocholic acid nephropathy (see balkan nephritis in textbooks), butin these cases - and when endemic - also Hanta virus infection has to be taken into account. This virus is transported by mice, rats etc. and may be spread in hygienically questionable situations.
No, we are just aware of several case in Austria, also in people on holidays in mountain areas, staying overnight in small mountain cottage and having had contact with excrements of rodents.
It is extremely difficult to find the etiology of CKD in most of these patients . In a three year study , we had 408 patients with CKD in Chennai , in whom 299 were diagnosed as unclassified , as the etiology could not be determined & Diabetes occurred in 65 cases only ( article - Management of Renal Failure in India : Strategy based on Peritoneal Dialysis. JAPI 1985 - available in my articles ) . Many of these patients were in the age group 20 - 40 years & had no past history of renal disease . It is not possible to do renal biopsy , because of the high risk of bleeding & data from histopathological examination may not be useful , because of grossly scarred kidneys . My personal view is that factors such as small kidneys at birth , probably due to low birth ( or unknown genetic factors ) or Glomerular / TubuloInterstitial diseases at young age , which was not clinically obvious , could have contributed to CKD . It is very difficult to predict events retrospectively , as our knowledge on etiology of CKD is limited in these group of young patients . We definitely need guidelines to screen patients who are young & the existing guidelines are for known risk factors , such as Diabetes , Hypertension & Chronic Glomerulonephritis .
It seems the pattern is similar in Sri Lanka too. It may be having similar etiopathogenesis to that in Chennai. It is heavily debated on organophosphates and fertilizers that contaminated with arsenic in our case, but without strong scientific evidence.
Guidelines on screening of young people are needed. However do we have a sensitive test/ tests.
Your data is similar to reports on CKD from Latin America . The only way to analyse this problem , would be screen the workers in the field for CKD . The tests to be done can be to look for urine proteinuria & serum creatinine . The controls can be family members who are not working in the fields . In those who have CKD , probably tests for arsenic or OPC could be done . It would be ideal if samples are taken before they start to work in the fields , as this would confirm that work in the fields is the cause of CKD , but is probably not practical .A well planned epidemiological survey is the only solution to evaluate this serious problem . If early CKD is detected , conservative treatment could delay progression of CKD & valuable lives could be saved .
Immunosupressive drugs such as cyclosporins, tachrolimus can some time causes chronic renal failure. Some of the siddha products can cause Chronic kidney failure (Not in all the patients, only in few cases).