CKDu Sri Lanka Kidney non-human RNA

Methods Here, we performed a prospective observational cohort study of symptomatic patients presenting with a feverish syndrome at an outpatient clinic in a CKDu-endemic region of Sri Lanka. Between June 2018 and November 2021, a cohort of 151 patients presenting with a feverish syndrome to an outpatient clinic in a CKDu endemic region in Sri Lanka were included in this study, 85 patients returned for follow-up. Serum Creatinine, CRP, Cystatin C and dipstick proteinuria were determined. Serum samples (n=32) were screened for antibodies against known human pathogenic viruses using the VirScanTM-Pipeline. Kidney biopsies (n=19) were investigated for the presence of viral pathogens using a PAN-Hanta-PCR and next-generation sequencing (NGS).ResultsThe prevalence of reduced eGFR at initial presentation was high, especially in men. After a median follow-up of 2.3 years, 16 patients had lost ≥4ml/min/1.73m2 eGFR per year and their eGFR was <90ml/min/1.73m2 at last follow-up. Patients with loss of eGFR clustered geographically. Virome screening did not identify any antibody reactivity in the loss of eGFR group. NGS-evaluation and Hanta-PCR of 19 kidneys biopsies did not detect viral pathogens.ConclusionA significant proportion of patients in a CKDu endemic region presenting with a feverish syndrome developed a substantial loss of eGFR during the following years. No evidence of a viral etiology was found.