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首页> 外文期刊>The Science of the Total Environment >Response to the commentary by M.W.C. Dharma-wardana on 'Chronic kidney disease of unknown etiology (CKDu): Using a system dynamics model to conceptualize the multiple environmental causative pathways of the epidemic'
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Response to the commentary by M.W.C. Dharma-wardana on 'Chronic kidney disease of unknown etiology (CKDu): Using a system dynamics model to conceptualize the multiple environmental causative pathways of the epidemic'

机译：响应M.W.c.的评论。 Dharma-wardana上“未知病因慢性肾病（CKDU）：使用系统动力学模型来概念化流行病的多种环境致病途径”

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We thank Professor Dharma-wardana for his constructive comments which have helped us to refine the model we proposed to conceptualize the etiology of CKDu (Jayasinghe and Zhu, 2020). At the core of his argument is that certain factors in the model have little support from existing evidence and are incomplete. CKDu (or CINAC) is now known to consist of a chronic interstitial nephritis or lysosomal tubulopathy, a picture also seen with cyclosporine or tacrolimus toxicity which are calcineurin inhibitors (CNIs) as well as other toxic nephropathies e.g. lithium, lomustine and clomiphene (Vervaet et al., 2020; Haas, 2020). Expressed differently, a range of insults to the kidney lead to the same histopathological features in the kidney and its related clinical features. If so, one could argue that the combination of factors contributing to the clinic-pathological picture of CKDu in Sri Lanka may differ from those in El Salvador or elsewhere. It is for this reason that the model includes factors that may be less substantiated in Sri Lanka, but reasonable enough to include in the model based on available data or our understanding of pathogenesis of chronic interstitial nephropathies. The other reason is that complex systems follow non-linear dynamics. Therefore, an exposure may appear to be unimportant or unrelated to toxicity below a particular level, yet have a significant and disproportionate impact above the threshold (Philippe and Mansi, 1998).
机译：我们感谢Dharma-Wardana教授，为他的建设性评论帮助我们改进了我们建议概念CKDU的病因（Jayasinghe和Zhu，2020）的模型。在他的论点的核心，这是该模型中某些因素从现有证据中的支持很少，并且不完整。 CKDU（或CINAC）现在已知由慢性间质性肾炎或溶酶体微管疗病组成，这张照片也看到了环孢菌素或巨虫毒蕈毒性，这些毒性是钙蛋白抑制剂（CNI）以及其他有毒的肾病。锂，拉莫斯汀和克罗米芬（Vervaet等，2020; Haas，2020）。表达方式不同，肾脏的一系列侮辱导致肾脏及其相关临床特征中相同的组织病理学特征。如果是这样，人们可以争辩说，斯里兰卡临床 - 康德村临床病理图片的因素组合可能与萨尔瓦多或其他地方不同。因此，该模型包括在斯里兰卡中可能不那么证实的因素，但足以基于可用数据或我们对慢性间质性肾病的发病机制的模型中的模型中的含量。另一个原因是复杂系统遵循非线性动态。因此，曝光可能看起来不重要或与低于特定水平的毒性不重要，但对阈值的影响很大而不成比例（Philippe和Mansi，1998）。

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  • 来源
    《The Science of the Total Environment》 |2020年第15期|137591.1-137591.2|共2页
  • 作者

    Saroj Jayasinghe; Yong-Guan Zhu;

  • 作者单位

    Department of Clinical Medicine University of Colombo Colombo Sri Lanka;

    Environmental Soil Science and Biogeochemistry Institute of Urban Environment Chinese Academy of Sciences Xiamen China;

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