Our Kidneys

By Dr Harold Gunatillake Health Writer

Our kidneys do a great job by excreting toxic material and other chemicals that harm our body. Liver plays an important part in this function, in assisting the kidneys by detoxifying toxic material from food we consume. In this natural detoxifying and elimination process, certain chemicals become challenges to the liver and kidneys. The obvious example that causes irreversible damage to the liver due to chronic exposure is alcohol, and kidneys also can bust due to chronic exposure to toxic chemicals, and lead to chronic kidney disease.

A new disease affecting a striking 15 percent of the residents in the North Central region of Sri Lanka is baffling not only the local experts but also the WHO, and other foreign researchers. Thousands of rice farmers are affected and according to the Ministry of Health, 15% of the population are affected, most of them are rice farmers.

These people did not have any pre-disposing factors, or chronic diseases like diabetes, hypertension, and common causes of kidney disease world-wide. To distinguish this disease from the common ones with known pre-disposing factors, it has been labelled 'Chronic Kidney Disease of Unknown Etiology-(CKDu).

This condition cannot be treated as the cause or causes are unknown, but it is common knowledge that for both kidneys to be affected, the source could be some chemical or chemicals getting absorbed, may be in minute amounts through inhalation, through skin, or ingestion. Four years ago, the World Health Organization (WHO) and the government of Sri Lanka launched an investigation into its causes. Samples of blood, urine, tissue samples, and the regional food, water and air were tested.

The WHO says it will publish the study in the coming months, but are still finalising details. Some doctors and scientists familiar with the study agree that more research needs to be done, but many assume that farm chemicals are at least partly to blame for CKDu. In its press release about the study, the government writes that preventing,"indiscriminate use of fertilizers and certain pesticides… can help protect the kidney".Yet little has been done to spread that message to the people who should hear it.

Farmers in the North Central Province say that they know nothing about the study. Nor have consumers been told what foods are most likely to be contaminated. The government says it will release that information after it has conducted more detailed studies. Similar mystery disease is also found in Costa Rica, Nicaragua, Guatemala, and El Salvador, and also India. In Sri Lanka the majority affected are rice farmers from certain localities, whilst in Central America the victims are mostly work on sugar cane plantations.

Relatively high levels of the metals showed up in the blood and urine of people in the North Central Province, says Palitha Mahipala, an official with the Sri Lankan Ministry of Health. Although the levels were generally within what is considered the safe range, Mahipala says that continuous exposure to those levels may have been damaging. But if arsenic and cadmium are to blame, where are they coming from? The new study blames farm chemicals, which are cheap in Sri Lanka. These are subsidized and often overused. Cadmium is found in some fertilizers.

Arsenic is an active ingredient in some pesticides. Companies importing and selling pesticides and herbicides contest the government's conclusion. They point out that the government and WHO have not yet released their full study.

Most of these fertilizers are imported from China, and what sort of chemicals and pesticides content in them have not been analysed. But on Aug. 14, 2012, a group of Sri Lankan doctors released a report that they said was compiled as part of an ongoing joint research project by the Sri Lankan government and the World Health Organization (WHO).

The report states: "Exposure to a combination of factors that are toxic to the kidneys (rather than one single factor) seems to cause this kidney disease. Toxic factors identified up to now include nephrotoxic agrochemicals, arsenic and cadmium."

As many as 400,000 people in the North-Central region may be suffering from kidney disease, said doctors taking part in the release of the report. They added that in the past two decades, as many as 22,000 people may have died as a result. "The reason for the spread is heavy metals in the water caused by the unregulated use of fertiliser and pesticides," Dr. Channa Jayasumana, from the Faculty of Medicine at the Rajarata University in Anuradhapura, told IPS.

Sources closely associated with WHO research said the organisation has in fact made a recommendation to the Sri Lankan government to regulate and standardise fertiliser and pesticide imports – the doctors' main demand. However, another report, published just one day after the study's release, dismissed heavy metals as the main cause. The report, "Environmental Contamination and Its Association with Chronic Kidney Disease of Unknown Etiology in North Central Region of Sri Lanka", released by the New Delhi-based Centre for Science and Environment (CSE), identifies poor water quality as the main reason for kidney failure in that region.

The report says: "Heavy metals in drinking water are not related to chronic kidney disease in Sri Lanka. If heavy metal is responsible, then there is a different source for it than drinking water, and that should be explored." CSE deputy director Chandra Bushan told IPS, "The problem is with the quality of the groundwater. It is contaminated due to geological and environmental reasons." But, he said, if fertilisers and pesticides were the main cause, then the disease should also be visible in other agricultural areas of the country with equally heavy use.

Following years of official research, the Sri Lanka's Health Ministry and World Health Organization declared in June 2011, that low level exposures to the heavy metals cadmium and arsenic were "causative factors" for the ailment – which they have named CKDu, Chronic Kidney Disease of unknown etiology.

Despite prior warnings from the WHO to reduce farmers' exposure to agrochemicals, the Sri Lankan government in 2011 lifted a temporary ban on pesticides it had found to be contaminated with small amounts of arsenic. The CSE report also found that dug wells and tube wells were much more dangerous than natural springs.

Farmers are not used to carrying bottles of water for drinking to the sites they work. They work long hours, sweating in the hot sun, and don't seem to know the importance of drinking lots of water whilst working in the field to prevent kidney disease. Farmers should drink more water to flush these chemicals out of the system.

According to the National Water Supply and Drainage Board, 80 percent of the population has access to "safe" water sources, but only 30 percent has access to piped water, which health experts say is safer than the more commonly used hand-dug wells.

Soaring temperatures in the dry zone seems to heighten the risk. Though Arsenic and cadmium have been blamed as nephrotoxic, so far the decision to ban such chemicals in pesticides is in limbo, and more farmers need dialysis to survive.

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