Sri Lanka - Chronic renal failure
Chronic renal failure in NCP and arsenic: Science versus myth
By Prof. Oliver A. Ileperuma
The media recently highlighted the claims by a group of Kelaniya University scientists and others that arsenic in pesticides was the factor responsible for chronic renal failure or chronic kidney disease of unknown origin (CKDU) in the North-Central Province. This disease was first detected by Dr. Tilak Abeyesekera, Consultant Nephrologist who was at that time working at the Anuradhapura general hospital.
oon there were many media reports highlighting this issue and in February, 2003, the Water Board took the initiative to get stakeholders including scientists to discuss the problem. At that time it was thought that this was an environmental related disease due to some toxic compounds in drinking water. This writer along with Dr. Dharmagunawardane, a geologist was given the task of investigating any possible geo-environmental causes. This initiated a collaborative research programme with medical personnel involved.
We visited the affected villages with the medical team comprising Dr. Tilak Abeyesekera and Dr. Nimmi Athureliye where positive CKDU patients were identified. Our team then visited the people so identified to observe their lifestyles including the water they drank, the food they ate and the utensils used for cooking and storing water. In less than six months we were able to identify one environmental factor which could be the most significant one involved in this disease. The geographic distribution of the disease closely paralleled the fluoride levels of drinking water. Almost all patients who reported to the Anuradhapura hospital with this disease came from high fluoride areas. As early as 2004, I put forward the hypothesis that fluoride in drinking water was the most likely reason for the prevalence of this disease.
Role of fluoride
A chance observation during the examination of the water storage pots and cooking utensils showed they developed holes in them after prolonged use. Chemically this is a well-known fact where aluminium dissolves forming fluoro complexes under high fluoride stress compared to low fluoride water in the wet zone. What is worse is that these holes are often sealed with lead solder and lead is known to be toxic to the kidney. These complexes are easily absorbed by the body and once inside the body, excessive fluoride is released into the different organs.
In experiments conducted in the USA on rats, it was found that the presence of fluoride as low as 1 part per million (ppm) in aluminium resulted in the death of the animals and the postmortem examinations revealed that the rats died due to kidney failure. Fluoride in excessive amounts is particularly toxic to the kidney and hence it is a reasonable theory to explain the occurrence of the disease. The type of aluminium pots used were of inferior quality and are made by melting scrap aluminum and usually contains other heavy metals as impurities such as lead, chromium and nickel. Good quality aluminium cooking pots are anodized and this gives a protective layer of aluminium oxide to the pot while these inferior quality pots are not anodized.
All these heavy metals are toxic to the kidney since they are finally filtered by the kidney before they are excreted. Furthermore, the use of sub-standard aluminium pots results in enhancing the fluoride intake since each Al can carry six fluoride ions into the body when it forms aluminofluoro complexes and they have the special ability to travel through biological membranes.
The use of aluminium pots came into practice only in the past two decades. Clay pots used earlier have the ability to absorb fluoride present in water and this explains why the disease was noted only in the last decade. Generally it requires at least 10-15 years of continuous exposure for this type of chronic poisoning to occur and damage the kidney........................
By Prof. Oliver A. Ileperuma
The media recently highlighted the claims by a group of Kelaniya University scientists and others that arsenic in pesticides was the factor responsible for chronic renal failure or chronic kidney disease of unknown origin (CKDU) in the North-Central Province. This disease was first detected by Dr. Tilak Abeyesekera, Consultant Nephrologist who was at that time working at the Anuradhapura general hospital.
oon there were many media reports highlighting this issue and in February, 2003, the Water Board took the initiative to get stakeholders including scientists to discuss the problem. At that time it was thought that this was an environmental related disease due to some toxic compounds in drinking water. This writer along with Dr. Dharmagunawardane, a geologist was given the task of investigating any possible geo-environmental causes. This initiated a collaborative research programme with medical personnel involved.
We visited the affected villages with the medical team comprising Dr. Tilak Abeyesekera and Dr. Nimmi Athureliye where positive CKDU patients were identified. Our team then visited the people so identified to observe their lifestyles including the water they drank, the food they ate and the utensils used for cooking and storing water. In less than six months we were able to identify one environmental factor which could be the most significant one involved in this disease. The geographic distribution of the disease closely paralleled the fluoride levels of drinking water. Almost all patients who reported to the Anuradhapura hospital with this disease came from high fluoride areas. As early as 2004, I put forward the hypothesis that fluoride in drinking water was the most likely reason for the prevalence of this disease.
Role of fluoride
A chance observation during the examination of the water storage pots and cooking utensils showed they developed holes in them after prolonged use. Chemically this is a well-known fact where aluminium dissolves forming fluoro complexes under high fluoride stress compared to low fluoride water in the wet zone. What is worse is that these holes are often sealed with lead solder and lead is known to be toxic to the kidney. These complexes are easily absorbed by the body and once inside the body, excessive fluoride is released into the different organs.
In experiments conducted in the USA on rats, it was found that the presence of fluoride as low as 1 part per million (ppm) in aluminium resulted in the death of the animals and the postmortem examinations revealed that the rats died due to kidney failure. Fluoride in excessive amounts is particularly toxic to the kidney and hence it is a reasonable theory to explain the occurrence of the disease. The type of aluminium pots used were of inferior quality and are made by melting scrap aluminum and usually contains other heavy metals as impurities such as lead, chromium and nickel. Good quality aluminium cooking pots are anodized and this gives a protective layer of aluminium oxide to the pot while these inferior quality pots are not anodized.
All these heavy metals are toxic to the kidney since they are finally filtered by the kidney before they are excreted. Furthermore, the use of sub-standard aluminium pots results in enhancing the fluoride intake since each Al can carry six fluoride ions into the body when it forms aluminofluoro complexes and they have the special ability to travel through biological membranes.
The use of aluminium pots came into practice only in the past two decades. Clay pots used earlier have the ability to absorb fluoride present in water and this explains why the disease was noted only in the last decade. Generally it requires at least 10-15 years of continuous exposure for this type of chronic poisoning to occur and damage the kidney........................
posted by Bill at
9:49 AM
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