“Chronic kidney disease of unknown origin (CKDu) is a leading public health concern in Sri Lanka. It is not attributable to any common risk factor, such as diabetes, hypertension or glomerular diseases. Despite being in an advanced stage of chronic kidney diseas(CKD),  a significant number of patients remain asymptomatic. Thus, the primary care physician may encounter patients with an advanced stage of CKDu who are seeking medical care for other health concerns We wish to write on patients have encountered this phenomenon during a study performed for  screening of healthy individuals from a CKDu endemic region in Sri Lanka…..”