Report on the International Continuing Medical Education (CME) program on Chronic Kidney Disease of Unknown Origin (CKDu) organised on 04.12.2019 at 11.00 am at Narayana Medical College, Nellore. Doctors from Karolinska Institute, Sweden participated in the session. Dr Praveen Kumar, Professor & Head Department of Nephrology organised the scientific program.

In her first talk, Dr Annika Wernerson, M.D., PhD, Academic Vice President of Higher Education, Karolinska University, Stockholm, Sweden described the University and compared it with Narayana Medical College. She expressed satisfaction that the facilities available at Narayana Medical College are of international standards and match those available in Sweden. She later described the salient histopathological features of the kidney biopsy specimen of CKD patients from Sri Lanka and Central America. She said that though the clinical picture appears to be similar in these patients from different continents, the histopathological features are various. She explained the different morphological changes seen in the kidney biopsies. Dr Julia Wijkstrom, CLINTEC, Stockholm, Sweden also demonstrated kidney specimen pictures about CKD patients
Dr Carl Gustaf, M.D., M.P.H., CLINTEC, Karolinska University, Stockholm, Sweden described the epidemiological picture of CKD and explained the causative factors of chronic kidney disease of unknown origin. He said that his work on heavy metals and pesticides in inducing the chronic kidney damage are inconclusive. He said the exact cause of CKDu is elusive and more extensive research is required. He urged that as the problem is prevalent in Nellore and Prakasam districts, Narayana Medical College should take up the initiative to conduct quality epidemiological studies. He also described that various causative factors related to genetics, diabetes, hypertension, Heat Stress, Pesticides, Heavy metals are causes for CKD. But none of these factors is found to be the causing chronic kidney damage. Dr Gangadhar Taduri, Professor & Head of Nephrology, Nizams Institute of Medical Sciences also participated in the discussion. He explained his experience with CKD in India. He said that his first contact with CKD was at Nellore. He elaborated that various studies carried out in Andhra Pradesh were able to identify that Silica concentration is high among people using groundwater. CKD was also found to be high among these individuals. However, the association between silica and CKD need investigation. He also reiterated that the water containing high concentration of when replaced with water purified through reverse osmosis, there is apparent decrease in the number of CKD patients in one village. However, the interpretation of findings of these studies needs caution. He said that Government of Andhra Pradesh is generous in helping the CKD patients financially every month. Dr Gangadhar noted that the team from Sweden would be assisting us in finding out the cause(s) of this disease.

Dr S P Rao, Dean Narayana Medical College profusely thanked the team members from Karolinska University, Stockholm, Sweden, for their participation and expertise. He said that the collaboration between Narayana Medical College and Karolinska University, Stockholm, Sweden would be fruitful in researching Chronic Kidney Disease problem. In the end, Dr Chakravarthy, Nephrologist from Apollo Hospitals, Nellore felicitated all the team members.