Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause?(Biomed Central, 2011) Wanigasuriya, K.P.; Peiris-John, R.J.; Wickremasinghe, R.BACKGROUND: The rising prevalence of chronic kidney disease (CKD) and subsequent end stage renal failure necessitating renal replacement therapy has profound consequences for affected individuals and health care resources. This community based study was conducted to identify potential predictors of microalbuminuria in a randomly selected sample of adults from the North Central Province (NCP) of Sri Lanka, where the burden of CKD is pronounced and the underlying cause still unknown. METHODS: Exposures to possible risk factors were determined in randomly recruited subjects (425 females and 461 males) from selected areas of the NCP of Sri Lanka using an interviewer administered questionnaire. Sulphosalicylic acid and the Light Dependent Resister microalbumin gel filtration method was used for initial screening for microalbuminuria and reconfirmed by the Micral strip test. RESULTS: Microalbumnuria was detected in 6.1% of the females and 8.5% of the males. Smoking (p < 0.001), alcohol use (p = 0.003), hypertension (p < 0.001), diabetes (p < 0.001), urinary tract infection (UTI) (p = 0.034) and consumption of water from wells in the fields (p = 0.025) were associated with microalbuminuria. In the binary logistic regression analysis, hypertension, diabetes mellitus, UTI, drinking well water in the fields, smoking and pesticide spraying were found to be significant predictors of microalbuminuria. CONCLUSIONS: Hypertension, diabetes mellitus, UTI, and smoking are known risk factors for microalbuminuria. The association between microalbuminuria and consumption of well water suggests an environmental aetiology to CKD in NCP. The causative agent is yet to be identified. Investigations for cadmium as a potential causative agent needs to be initiated.Item Frequency, pattern and short-term outcome of chronic renal dysfunction in patients with cirrhosis(Wiley Blackwell Scientific Publications, 2013) Perera, K.R.P.; de Silva, S.T.; Niriella, M.A.; Pathmeswaran, A.; de Silva, H.J.OBJECTIVE: Current criteria fail to detect milder degrees of renal dysfunction in cirrhosis, and exclude hepatorenal syndrome (HRS1, HRS2) in patients with structural kidney disease. Definitions addressing this have been proposed by Working Party of the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC). We studied the frequency, pattern and outcome of renal dysfunction in patients with cirrhosis using ADQI-IAC definitions. METHODS: Consecutive patients attending outpatient clinics in Colombo North Teaching Hospital, Ragama, were prospectively recruited and followed up. RESULTS: Of 277 patients with cirrhosis and stable serum creatinine, 27 (9.7%) had serum creatinine >1.5 mg/dl (current cut-off), and 23/27 (85%) fulfilled criteria for HRS2. 65/277 (23.5%) had eGFR <60 ml/min [ADQI-IAC cut-off for chronic kidney disease (CKD)], but 42/65 (64.6%) did not fulfil criteria for HRS2. Compared to cirrhotics without CKD, the CKD group were older (61.4 vs 53.7 years; p < 0.0001), more likely to be female (50.8% vs 19.3%; p < 0.0001), more likely to have cryptogenic cirrhosis (67.7% vs 41%; p < 0.0001), and Child-Pugh class B or C (95.4% vs 74%; p < 0.001). As expected, they had higher MELD scores (16.6 vs 13.5; p < 0.0001). 58/277 (20.9%) died during follow-up [mean 9.8 months (SD 4.5)]. After adjusting for other variables, CKD independently increased risk of death 3.3-fold (Nagelkerke R Square test). CONCLUSION: Compared to HRS criteria, the ADQI-IAC definition detects more than twice the number of cirrhotic patients with CKD. As the presence of CKD is associated with increased mortality, further studies are needed to determine whether prognosis can be improved in such patients by treating acute deterioration of CKD with available treatments for HRS1.Item Exposure to acetylcholinesterase-inhibiting pesticides and chronic renal failure(Sri Lanka Medical Association, 2006) Peiris-John, R.J.; Wanigasuriya, J.K.; Wickremasinghe, A.R.; Dissanayake, W.P.; Hittarage, A.No Abstract Available.