Do pregnant women living in endemic regions of chronic kidney disease of unknown origin (CKDu) show pathological changes in the placenta?

There had not been much research to find possible involvement of other organs other than the kidney in CKDu. The effects on pregnancy due to renal impairment in general is known2,3 but what other damage could be inflicted by the unknown aetiology of CKDu on feto placental unit remains unknown.This injury could precede overt renal impairment. One such vulnerable organ is the placenta as both kidneys and placenta share similar function as filtration barriers. It is logical to assume if an agent could affect the interstitium of the kidney, similar adverse effects could be imposed on the interstitium of haemochorionic human placenta. This study was designed with the objective of analysing possible effects on human placental structure of patients who have been exposed to the probable aetiological factor responsible for CKDu. Obviously, anything affecting placenta would adversely affect fetus, its growth and organ development. If the agent passed through to the fetus, there could be similar direct damage to fetal kidneys too. 240 placental samples of women who had lived at least 10 years in a highly endemic area were compared with a similar number from those who were not so exposed. All samples were processed at the department of pathology and reported on by the second author. There was statistically insufficient evidence to conclude that population proportions of two categories were significantly different. The differences between categories and abnormalities were statistically insignificant. Since there was no noticeable Light Microscopic changes observed attributable to an unknown pathological agent, it was concluded that during a 9-months period of exposure of the placenta, no significant changes occurred even in the most endemic areas. This data was useful as women attending antenatal clinics could be reassured that no ill effect of the agent is known and it would be unnecessary to abandon home during pregnancy for safety of the fetus.