Advanced Technology Institute, University of Surrey, Guildford, UK.
Department of Chemistry, University of Surrey, Guildford, UK.
Environ Geochem Health. 2023 Jun;45(6):2647-2662. doi: 10.1007/s10653-022-01373-y. Epub 2022 Sep 12.
Chronic kidney disease of uncertain aetiology (CKDu) is an advanced version of chronic kidney disease (CKD) which bears a high burden on the world health economy. More than 200 articles were analysed to understand the disease responsible for more than 30,000 deaths per year. CKDu is a non-communicable occupational disease that has a progressive deterioration of the kidney in the absence of CKD risk factors such as hypertension, diabetes and glomerulonephritis, while the diagnosis is only possible at the later stages when kidney function is no longer effective. Published evidence for the existence of CKDu was found for around 35 countries. This is a growing health issue in Asia, Central America, Africa and Middle East with identified hot spots. Despite many research studies over decades, the exact root causes are still uncertain. Six main suspected causative factors are identified. Those are heat stress, strenuous labour, dehydration, use of agrochemicals, exposure to heavy metals and the use of polluted water and agricultural lands. This review summarizes four key areas which are CKDu and its general medical background, worldwide prevalence, suspected causative factors and potential circumventing steps to mitigate against CKDu. The importance of further studies addressing early detection and surveillance methods, contribution of nephrotoxins in environmental health, soil chemistry on transporting nephrotoxins, geological parameters which influence the prevalence of the disease and other related sectors to overcome the mysterious nature is highlighted. Mitigation steps to lessen the burden of CKDu are also identified.
病因不明的慢性肾病（CKDu）是慢性肾病（CKD）的一种晚期形式，给世界卫生经济带来了沉重负担。分析了 200 多篇文章，以了解导致每年超过 3 万人死亡的疾病。CKDu 是非传染性职业病，在没有高血压、糖尿病和肾小球肾炎等 CKD 危险因素的情况下，肾脏逐渐恶化，而只有在肾功能不再有效的晚期才能进行诊断。在大约 35 个国家发现了存在 CKDu 的证据。这是亚洲、中美洲、非洲和中东日益严重的健康问题，存在热点地区。尽管几十年来进行了许多研究，但确切的根本原因仍不确定。确定了六个主要疑似致病因素。这些因素是热应激、剧烈劳动、脱水、使用农用化学品、接触重金属以及使用受污染的水和农田。这篇综述总结了四个关键领域，即 CKDu 及其一般医学背景、全球流行情况、疑似致病因素以及减轻 CKDu 的潜在规避措施。强调了进一步研究的重要性，包括早期检测和监测方法、环境健康中肾毒素的作用、运输肾毒素的土壤化学、影响疾病流行的地质参数以及其他相关领域，以克服其神秘性质。还确定了减轻 CKDu 负担的缓解措施。
