Shirani Ranasinghe1,2,3,4,*, Chathura Ranasinghe5, Han Ziming1,4, Ashraful Islam1,4, Thanusha Perera6, Yu Zhang1,4 and Min Yang1,3,4
Affiliation: 1State Key Laboratory of Environmental Aquatic Chemistry, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China, 2Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Sri Lanka, 3Joint Research Development Center, E O E Pereira Mawatha, Meewatura, 20400 Peradeniya, Sri Lanka, 4University of Chinese Academy of Sciences, Beijing 100049, China, 5District General Hospital Nawalapitiya, Dimbula Road, Nawalapitiya, Sri Lanka and 6Lincoln University, Malaysia
Email: [email protected]
Abstract: Despite much research on chronic kidney disease of uncertain etiology (CKDu) in Sri Lanka the etiology and pathogenesis of this disease remains as a debated topic. The fluoride level in the ground water in CKDu prevalent area was considered as one of the suspected etiological factor for the condition. A scoping review was conducted through MEDLINE and Google Scholar databases for peer reviewed publications on ground water analysis related to CKDu areas globally. Groundwater plays as the primary source of drinking water. The occurrence of the disease and the fluoride metabolism in the CKDu patients would give much evidence for the correlation. The factors which decide the water intake of a person, and the fluoride level in the ground water are the critical factors for fluoride intake. There are recommended levels of fluoride for each country. The pathogenesis of Fluoride for the renal damage was well described at cellular level changes. It is associated with oxidative stress leading to organelle damage. Therefore, urinary fluoride can be used as an early indicator of CKDu. Further, Fluoride toxicity is reported with combination of heavy metals such as Mg, Mn and As, Pb etc. Although no clear etiological factor was recognized, Fluoride could be considered as a possible etiological factor for CKDu. As preventive measures, provision of fluoride-free drinking water in the affected areas, early detection of fluoride toxicity can be recommended.
Keywords: Fluoride; Etiology of CKDu; Groundwater; Drinking Water; Heavy Metals.