Centre for Research, National Hospital, Kandy, Sri Lanka.
Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.
Nephron. 2023;147(8):510-520. doi: 10.1159/000528703. Epub 2023 Feb 21.
Chronic kidney disease of uncertain etiology (CKDu) is an environmental nephropathy in which the etiological factors are yet uncertain. Leptospirosis, a spirochetal infection that is common among agricultural communities, has been identified as a potential etiology for CKDu beyond environmental nephropathy. Although CKDu is a chronic kidney disease, in endemic regions, an increasing number of cases are reported with features suggestive of acute interstitial nephritis without any known reason (AINu), with or without background CKD. The study hypothesizes that exposure to pathogenic leptospires is one of the causative factors for the occurrence of AINu.
This study was carried out using 59 clinically diagnosed AINu patients, 72 healthy controls from CKDu endemic region (endemic controls [ECs]), and 71 healthy controls from CKDu non-endemic region (non-endemic controls [NECs]).
The seroprevalence of 18.6, 6.9, and 7.0% was observed in the AIN (or AINu), EC, and NEC groups, respectively, from the rapid IgM test. Among 19 serovars tested, the highest seroprevalence was observed at 72.9, 38.9, and 21.1% in the AIN (AINu), EC, and NEC groups, respectively, by microscopic agglutination test (MAT), particularly for serovar Leptospira santarosai serovar Shermani. This emphasizes the presence of infection in AINu patients, and this also suggests that Leptospira exposure might play an important role in AINu.
These data suggest that exposure to Leptospira infection could be one of the possible causative factors for the occurrence of AINu, which may lead to CKDu in Sri Lanka.
原因不明的慢性肾病（CKDu）是一种环境性肾病，其病因尚不确定。钩端螺旋体病是一种常见于农业社区的螺旋体感染，已被确定为 CKDu 除环境性肾病以外的潜在病因。虽然 CKDu 是一种慢性肾病，但在流行地区，越来越多的病例报告具有急性间质性肾炎的特征，而无任何已知原因（AINu），伴有或不伴有背景性 CKD。该研究假设接触致病性钩端螺旋体是 AINu 发生的一个致病因素。
本研究采用 59 例临床诊断为 AINu 的患者、72 例来自 CKDu 流行区的健康对照者（流行区对照者[ECs]）和 71 例来自 CKDu 非流行区的健康对照者（非流行区对照者[NECs]）。
快速 IgM 试验分别在 AIN（或 AINu）、EC 和 NEC 组中观察到 18.6%、6.9%和 7.0%的血清阳性率。在检测的 19 种血清型中，通过显微镜凝集试验（MAT），AIN（AINu）、EC 和 NEC 组的血清阳性率分别为 72.9%、38.9%和 21.1%，最高为血清型 Leptospira santarosai 血清型 Shermani。这强调了 AINu 患者存在感染，这也表明钩端螺旋体暴露可能在 AINu 中发挥重要作用。
这些数据表明，接触钩端螺旋体感染可能是 AINu 发生的一个可能致病因素之一，这可能导致斯里兰卡 CKDu 的发生。
