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Abstract: TH-PO427

Clinical Considerations Surrounding CKD of Undetermined Etiology (CKDu): Expert Consensus from the Third International Workshop on CKDu

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Raines, Nathan H., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Hidalgo, Guillermo, Eastern Carolina University, Greenville, North Carolina, United States
  • Garcia salazar, Nelson Benito, MINSA - SILAIS Chinandega, León, Nicaragua
  • Herath, Chulani Aravinda, Sri Jayawardenepura General Hospital, Colombo 5, Sri Lanka
  • Garcia-Trabanino, Ramon, Centro de Hemodialisis, San Salvador, El Salvador
  • Taduri, Gangadhar, Nizams Institute of Medical Sciences, Hyderabad, TELANGANA, India
  • Cipriano, Ever Olivie, Instituto Guatemalteco de Seguridad Social, Guatemala, Guatemala
  • Mendley, Susan R., NIDDK/NIH, Bethesda, Maryland, United States
  • Correa-Rotter, Ricardo, Institutor Nacional de la Nutricion, Mexico City, Mexico

CKDu is a term that describes a pattern of endemic, non-diabetic, non-hypertensive kidney diseases characterized by reduced GFR without nephrotic range proteinuria or features of glomerulonephritis. It has been described most extensively in rural communities in Mesoamerica, Sri Lanka, and India, although the global extent is unknown. The underlying etiology or etiologies of CKDu remains incompletely understood, and there are no consensus guidelines for CKDu management.


The Third International Workshop on CKDu was held March 20-22, 2019 in San Jose, Costa Rica. Our working group, comprised of clinicians who care for CKDu patients in Sri Lanka, India, and Mesoamerica as well as CKDu researchers, developed an expert consensus on the on clinical features and management of the disease.


While there are many similarities in the clinical aspects of CKDu in India, Sri Lanka, and Mesoamerica, there are notable differences as well. Individuals affected in Mesoamerica are younger (aged 20-40 as opposed to 20-60). Both regions show a high male-to-female ratio, and familial concordance. Affected individuals largely live in poverty. Most work in agriculture and live in rural areas, although not all. Hypokalemia, hyponatremia, minimal proteinuria, and sterile pyuria are highly prevalent. Individuals in Central America but not India or Sri Lanka can have hyperuricemia and urate crystalluria. Early biopsies demonstrate tubulointerstitial nephritis with a lymphocytic infiltrate. Both regions describe AKI episodes which may or may not be associated with CKDu. Clinical management in early stages of CKDu focuses on appropriate hydration with clean water, minimization of exposure to heat and agrichemicals, and correction of electrolyte disturbances. Timely diagnosis and establishment of nephrology care appears to improve outcomes.


More studies on the clinical aspects and management of CKDu are desperately needed; to date there is little published guidance for clinicians and health care policymakers. Nevertheless, based on our experience there are concrete actions which can be taken by both healthcare providers and governments to care for people affected by CKDu.


  • NIDDK Support