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Objective.  To infer the influence of internal and external oxidative stress in chronic kidney disease patients of unknown etiology (CKDu) in Sri Lanka, by analyzing expression of genes related directly or indirectly to oxidative stress: glutamate-cysteine ligase catalytic subunit (GCLC), glutathione S-transferase mu 1 (GSTM1), glucose-6-phosphate dehydrogenase (G6PD), fibroblast growth factor-23 (FGF23), and NLR family pyrin domain containing 3 (NLRP3).  Methods.  Reverse transcription quantitative polymerase chain reaction (RT-qPCR) was carried out for the selected populations: CKDu patients ( n  = 43), chronic kidney disease patients (CKD;  n  = 14), healthy individuals from a CKDu endemic area (GHI;  n  = 9), and nonendemic area (KHI;  n  = 16). Fold changes were quantified relative to KHI.  Results.  GCLC had greater than threefold upregulation in all three study groups, with a maximum of 7.27-fold upregulation in GHI ( p  = 0.000). GSTM1 was not expressed in 25.6% of CKDu and 42.9% of CKD patients, but CKDu patients expressing GSTM1 showed upregulation of 2.60-fold ( p  < 0.05). Upregulation of FGF23 and NLRP3 genes in CKD and CKDu was observed ( p  < 0.01), with greater fold changes in CKD.  Conclusion.  Results suggest higher influence of external sources of oxidative stress in CKDu, possibly owing to environmental conditions.

Upregulation of Oxidative Stress Related Genes in a Chronic Kidney Disease Attributed to Specific Geographical Locations of Sri Lanka