by Dr.M.A.C.S. Jayasumana
Department of Physiology,
Faculty of Medical and Allied Sciences,
Rajarata University of Sri Lanka.
kidney disease (CKD) is a growing worldwide health problem. The
aetiology varies between countries but Diabetes and Hypertension
are usually dominant factors in other parts of the world.
In recent years we have noticed a very worrying
abnormal increase in the number of patients with chronic kidney
Disease in certain parts of North central, Eastern and Uva
Provinces in Sri Lanka. Some authors name this disease as the
Rajarata Kidney Disease.
Interestingly, we can observe higher number of
CKD patients from the villages located adjacent to so called
Eelam ,Madawachchiya, Padaviya,Sripura, Madirigiriya,
Girandurukotte (see map 01).
Unfortunately, still no national Chronic Kidney
Disease database is available in Sri Lanka. But according to
health sector statistics more than 6,000 cases have been
reported for the last 5 years. Most of them are from above
mentioned areas which we can dub "CKD Belt".
The disease onset is in adolescence and number
of cases Reported increases with increasing age. These patients
typically present with non specific signs and symptoms,
lethargy, weakness, moderate anemia and mild hypertension.
Western medical studies conducted so far suggest that a common
although yet unknown aetiology, leading to marked
Tubulointerstitial fibrosis of the kidney that finally causes
Irreversible kidney failure. Renal Biopsies showed
TubuloInterstitial disease in more than 80% of the cases.
Even though several studies have been conducted
the aetiology still remain largely unknown. Following are some
of the current theories put forward.
01. Excessive quantities of naturally found
fluoride in the ground water which can harm the kidney.
02. Excessive use of fertilizers, Insecticides,
03. The use of aluminum utensils made out of low
quality cheap Aluminum to store water and to prepare food. The
fluoride content found in the groundwater reacts with the
Aluminum creating Toxic compounds (ALF x)
04. Entry of Toxic element such as Cadmium via
05. Excessive consumption of poor quality
When we consider the geographical distribution
of the outbreak, any of the above theories are unable to give a
consistent explanation for the existing problem. According to
Prof. C. B. Dissanayaka (1991) high amount of fluoride in the
groundwater can be seen in all parts of the Dry zone while
chronic kidney disease is highly prevalent only in "CKD Belt"
Excessive use of fertilizers, Aluminum utensils
and poor quality illegal liquor are not limited to certain parts
of the country, those are countrywide problems.
This disease shows some similarity with
previously observed Balkan Endemic Nephropathy (BEN) which is
also an Irreversible kidney disease of unknown origin. BEN
geographically confined to several rural regions of Bosnia,
Croatia, Serbia and Bulgaria where disease occurs only in rural
areas located in alluvial valleys of tributaries of the Lower
It is estimated that several thousand people in
the affected countries are currently suffering from chronic
kidney disease much similar to the condition in Sri Lanka. What
we have to remember is this Balkan area is also subject to
With regard to Sri Lanka chronic kidney Disease,
the causative factor could be a bioterrorism. The usual meaning
of Bioterrorism is the use of biological agents, such as
pathogenic organisms or agricultural pests for terrorist
High prevalence of disease can be seen in the
villages located adjacent to the so-called Eelam. For the last 2
– 3 decades these villages were repeatedly attacked by LTTE
terrorists and hundreds of unarmed innocent farmers brutally
killed. Even after these killing sprees, the terrorists were not
able to achieve their target of driving the villagers away. It
may be that they have changed their strategy.