Nvi Ratnatunga

Endemic chronic kidney disease of unknown etiology in Sri Lanka: Correlation of pathology with clinical stages

Chronic kidney disease of unknown etiology (CKDU) is endemic among the rural farming communities in several localities in and around the North Central region of Sri Lanka. This is an interstitial type renal disease and typically has an insidious onset and slow progression. This study was conducted to identify the pathological features in the different clinical stages of CKDU. This is a retrospective study of 251 renal biopsies identified to have a primary interstitial disease from regions endemic for CKDU. Pathological features were assessed and graded in relation to the clinical stage. The mean age of those affected by endemic CKDU was 37.3 ± 12.5 years and the male to female ratio was 3.3:1. The predominant feature of stage I disease was mild and moderate interstitial fibrosis; most did not have interstitial inflammation. The typical stage II disease had moderate interstitial fibrosis with or without mild interstitial inflammation. Stage III disease had moderate and severe interstitial fibrosis, moderate interstitial inflammation, tubular atrophy and some glomerulosclerosis. Stage IV disease typically had severe interstitial fibrosis and inflammation, tubular atrophy and glomerulosclerosis. The mean age of patients with stage I disease (27 ± 10.8 years) was significantly lower than those of the other stages. About 79.2%, 55%, 49.1% and 50% in stage I, II, III and IV disease respectively were asymptomatic at the time of biopsy.

Pattern of lymphoma subtypes in a cohort of Sri Lankan patients

OBJECTIVES To investigate the pattern of World Health Organization (WHO) lymphoma sub types in a sample from Sri Lanka. METHODS Retrospective, descriptive study was carried out using biopsy specimens of patients diagnosed or suspected to have a lymphoma received by the Department of Pathology, University of Peradeniya for WHO sub typing. A sample of 227 cases diagnosed to have a lymphoma. All lymphomas were sub classified according to WHO 2007 revised classification of haematopoietic and lymphoid neoplasm using immunohistochemistry. RESULTS There were 35 (15.4%) Hodgkin Lymphoma (HL) and 192 (84.6%) non Hodgkin Lymphoma (NHL) specimens. Of the NHL the common sub types were diffuse large B cell lymphoma 87 (38.3%), follicular lymphoma 26 (11.5%) and peripheral T cell lymphoma 25 (11%). Of the HL the common sub types were mixed cellular 20 (8.8%) and nodular sclerosis 13 (5.7%). The mean age of the patients was 48.8 ± 19.3 years and male to female ratio was 1.4:1. The observed patterns of both HL and NHL in the study population were similar to those of other South Asian countries such as India and Pakistan. CONCLUSIONS In the Sri Lankan sample, common sub types of lymphoma were diffuse large B cell lymphoma and follicular lymphoma. The frequency of lymphoma subtypes in the Sri Lankan sample are in accordance with the globally observed variations and similar to those observed in other South Asian countries.

Pathological characteristics of fifty patients with renal amyloidosis in Sri Lanka

Renal involvement is the most important cause of morbidity and mortality in systemic amyloidosis. This retrospective analysis was conducted to analyse the clinico-pathological characteristics of renal amyloidosis in a group of Sri Lankan patients undergoing renal biopsy. Renal amyloidosis was observed in 50/ 9712 (0.5%) renal biopsies. The underlying cause for amyloidosis was not known in most. Of the known causes multiple myeloma was the commonest. Nephrotic range proteinuria was the most common clinical outcome and most had grade I to III chronic kidney disease at the time of diagnosis. Glomerulosclerosis was associated with the deterioration of renal function.

Pattern of clinical benign euthyroid goitre in a tertiary care center in the Central Province of Sri Lanka from 1981-2011

Objectives To describe the pattern of clinical euthyroidgoitre in a tertiary care unit in Sri Lanka before and after iodination of salt in Sri Lanka. Methods We reviewed our thirty-one year computerised database of patients with goitres, spanning iodination in 1995. Results Prevalence of euthyroid clinical simple diffuse goitre did not reduce during the first thirteen years (p=0.822). However, it reduced in the latter four years from 2008 to 2011. There is significant reduction of prevalence in the younger age groups (p<0.001). A significant reduction of nodular change was observed in all groups within seven years after iodination (p<0.001). Conclusions There was a significant reduction in the prevalence of clinical nodularity in the post-iodination era in all age groups. Reduction in prevalence of clinical euthyroid simple diffuse goitre was observed only during the period 2008-2011.

A rare case of congenital fibre type disproportion causing delayed motor milestones.

Congenital myopathies are a clinically, genetically and pathologically heterogeneous group of muscle disorders. Congenital fiber type disproportion (CFTD) is a rare type of congenital myopathy which presents with hypotonia, delayed motor milestones and dysmorphic facies. Ceylon Medical Journal 2015; 60 : 33-34 DOI: http://dx.doi.org/10.4038/cmj.v60i1.7570

Fatal pulmonary haemorrhage following adenovirus infection

Adenoviruses (AdVs) are non-enveloped, doublestranded DNA viruses that vary in size from 70 to 100 nm. AdV infections commonly affect infants and children aged around 5 months to 6 years [1]. They are common pathogens of respiratory and gastrointestinal tracts, urethral canal and eyes characterised by self-limiting infection although fatal infections can occur in the immuno-compromised and occasionally in healthy children and adults [2].

Could the latex of Semecarpus anacardium (Kiri Badulla) cause nephrotic syndrome

Minimal change disease (MCD) accounts for 10-15% of primary nephrotic syndrome cases in adults [1]. Most cases are idiopathic. However, approximately 10% may have an identifiable cause. Secondary causes may include drugs, toxins, infections and tumours [2]. Non-steroidal anti-inflammatory drugs (NSAIDs) mercury, lithium and bee stings are some established causes of MCD. Although some plant products are known to cause nephrotoxicity, external contact of plant latex has not been reported as a nephrotoxin. We are reporting a possible case of an unusual cause of nephrotic syndrome following skin contact of latex of Semecarpus anacardium (SA). To the Editors: