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Background <p>Chronic kidney disease of unknown origin (CKDu) primarily affects tropical agricultural countries. Renal deposition of calcium nanocrystals and nanotubes causes it. Thus, it was renamed crystal tubular nephropathy (CKD–CTN). CKD–CTN remains a major public health crisis in Sri Lanka’s dry-zone farming regions and other equatorial countries, especially Central America, with severe social and economic consequences.</p> Methods <p>We searched public databases since 2000 using keywords to identify relevant articles. The data were systematically compiled and synthesized into a narrative review, integrating recent findings to elucidate the most likely factors contributing to the onset of CKD–CTN.</p> Results <p>Recent studies ruled out previously claimed agrochemicals, heavy metals, arsenic, and other nephrotoxins, as well as heat stress as causes. In contrast, evidence points to prolonged consumption of naturally contaminated groundwater as the primary cause. For the disease to manifest, however requires behavioral factors, such as chronic sustained dehydration, routine alcohol use, poverty-related malnutrition, etc. Together, these create sustaineddehydration—ideal conditions for calcium crystal precipitation in renal tissues-a slow process, which gradually grow in the presence of fluoride into stable crystals, damaging kidneys and leading to CKD–CTN.</p> Conclusions <p>The review examines the current understanding of CKD–CTN, highlighting key environmental, biological, social, and occupational constrains and factors. It calls for a national strategy—public education, health interventions, environmental monitoring, nutritional support, policy reforms, and—most critically—universal access to affordable potable water. It stresses the urgency of sustainable water management, education, and stronger rural healthcare systems to mitigate this deadly disease AND its impact. The authors offer practical guidance for future research, interventions, and policies to prevent the burden of CKD–CTN on communities.</p>

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The silent epidemic of CKDu: advances, challenges, and strategies for sustainable eradication—a narrative review

  • 期刊论文

  • 发表日期：

    2025年9月20日

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  • G. R. Diwyanjalee,
  • S. J. Wimalawansa

摘要

Background

Chronic kidney disease of unknown origin (CKDu) primarily affects tropical agricultural countries. Renal deposition of calcium nanocrystals and nanotubes causes it. Thus, it was renamed crystal tubular nephropathy (CKD–CTN). CKD–CTN remains a major public health crisis in Sri Lanka’s dry-zone farming regions and other equatorial countries, especially Central America, with severe social and economic consequences.

Methods

We searched public databases since 2000 using keywords to identify relevant articles. The data were systematically compiled and synthesized into a narrative review, integrating recent findings to elucidate the most likely factors contributing to the onset of CKD–CTN.

Results

Recent studies ruled out previously claimed agrochemicals, heavy metals, arsenic, and other nephrotoxins, as well as heat stress as causes. In contrast, evidence points to prolonged consumption of naturally contaminated groundwater as the primary cause. For the disease to manifest, however requires behavioral factors, such as chronic sustained dehydration, routine alcohol use, poverty-related malnutrition, etc. Together, these create sustaineddehydration—ideal conditions for calcium crystal precipitation in renal tissues-a slow process, which gradually grow in the presence of fluoride into stable crystals, damaging kidneys and leading to CKD–CTN.

Conclusions

The review examines the current understanding of CKD–CTN, highlighting key environmental, biological, social, and occupational constrains and factors. It calls for a national strategy—public education, health interventions, environmental monitoring, nutritional support, policy reforms, and—most critically—universal access to affordable potable water. It stresses the urgency of sustainable water management, education, and stronger rural healthcare systems to mitigate this deadly disease AND its impact. The authors offer practical guidance for future research, interventions, and policies to prevent the burden of CKD–CTN on communities.