Qualitative and Quantitative Dermatoglyphics of Chronic Kidney Disease of Unknown Origin in Sri Lanka

Background Chronic kidney disease (CKD) is a global public health problem and a devastating form of CKD has been observed recently in several regions, including Sri Lanka, Central America, India, and Egypt which was not attributed to conventional risk factors. It has been referred to as CKD of unknown etiology (CKDu), and recent evidence suggested causative factors could be of environmental and/or occupational origin. Dermatoglyphics is the study of the epidermal ridge patterns on the skin of the fingers, palms, toes, and soles. The relationship between different dermatoglyphic traits and various medical diseases have been widely evaluated and the main hypothesis for support of this association is ―if the growth of the limbs is disturbed in very early fetal life, changes in the epidermal ridge configurations are likely. The extent to which the average individual departs from perfect symmetry is fluctuating asymmetry (FA). FA is then a population level measure of developmental instability, robustness and developmental noise that is influenced by genetic factors and their interaction with environmental stresses. Dermatoglyphic asymmetry can be used to measure developmental instability during a specific period of human fetal development. Fluctuating asymmetry has been seen in dermatoglyphics as primarily concerned with the impact of environmental stress or noise that disrupts usual genetic expression. The present study was planned to systematically review dermatoglyphics in kidney disease and investigate whether digital and Palmar dermatoglyphics of CKDu patients in Sri Lanka are different from healthy people.

Methods This study was conducted in two components. In a systematic review, Electronic databases and grey literature were searched to earliest date to 17 April 2014. Review was reported, according to the Preferred Reporting Items for Systematic Reviews and MetaAnalyses checklist. In component 2, a case control study was carried out among CKDu patients (90 Males, 90 Females) from a CKDu endemic area and gender-matched two control groups; one group from a CKDu endemic region (90 Males, 90 Females) and another group from a CKDu non-endemic region (90 Males, 90 Females). Dermatoglyphics were obtained using photographic methods. Both qualitative and quantitative dermatoglyphic variables were defined and analyzed according to standard criteria. Both directional (DA) and fluctuating asymmetry (FA) were assessed.

Results Systematic review revealed that whorl pattern frequency and total ridge count have been used widely to investigate the uncertainty related to the origin of several kidney diseases such as Wilms tumor and adult polycystic kidney disease type III. Further it was evident that methodological errors such as inadequate sample size and/or inconsistency between cases and control groups in appraised studies limits the validity of the positive findings. The case control study revealed that several qualitative digital and Palmar DG variables had significant association with CKDu. When comparing CKDu cases with NEC; a significantly higher percentage of double loop pattern was observed on the left digit (LD) 3 while a higher percentage of central pocket loop pattern was seen on LD 2 and the frequency of plain whorl pattern was lower on LD2. In contrast, a significantly lower percentage of palin arch pattern was observed on right digit 3 in CKDu cases.The triradii a1 variable was significantly lower in palms of CKDu cases in both genders when compared to both control groups. The FA of pattern discordance (right vs left hands) between CKDu cases vs control group were significant in two digits (digit 3 in males and digit 2 in females). Significant differences in FA also were observed for digit 2 ridge count (RC) in cases versus both control groups in females. . In females, AB RC was significant in the cases versus N7EC. In males, significant differences can be seen with regard to CKDu cases for AB RC and the EC, and in digit 3 RC, total RC, and AB RC in the tests against the NEC.

Conclusion Based on these results it is proposed that the mechanisms responsible for the development of CKDu might be associated with those responsible for FA observed in CKDu patients.

Awards received for this work

1. Best oral presentation First prize, 7th Annual academic sessions of Anuradhapura clinical society with Foundation Sessions of The Sri Lanka Medical Association, 2013.
2. National Research Council Merit Awards for Scientific Publication 2013
3. Best Poster PresentationFirst prize, Annual Acadamic Sessions, 2015, Sri Lanka Heart Association, Cinnamon Grand Hotel, Colombo. 
4. National Research Council Merit Awards for Scientific Publication 2016
5. Asia-Pacific Academic Consortium for Public Health Poster award, 48th  Asia-Pacific Academic Consortium for Public Health Conference, Teikyo University Tokyo Japan, 2016.

List of Publications from the MPhil

1        Wijerathne BTB, Meier RJ, Salgado SS, Agampodi SB. Dermatoglyphics in kidney diseases: a review. Springerplus 2016; 5: 290.

2        Wijerathne BTB, Meier RJ, Agampodi TC, Agampodi SB. Dermatoglyphics in hypertension: a review. J Physiol Anthropol 2015; 34: 1–12.

3        Wijerathne BTB, Meier RJ, Salgado SS, Agampodi SB. Uncommon Palm Prints: Can They be Used for Forensic Identification? J Forensic Sci 2016; 61: 1388–1388.

4        Wijerathne B, Meier R, Salgado S, Agampodi S. Hemoglobin A1c values in CKDu endemic and non endemic regions of Sri Lanka. Diabetes Res Clin Pract 2017; 134: 206–7.

5        Wijerathne BTB. Poroscopy: an important research field in Medicine and Physical Anthropology. Anuradhapura Med J 2015; 9: 44.

6        Wijerathne BTB. Fingerprints: can poroscopy be useful in diabetes research? Pract Diabetes 2015; 32: 113.

7        Wijerathne BTB, Meier RJ, Salgado LSS, Rathnayake GK, Kumara SS, Agampodi SB. Chronic kidney disease of unknown etiology: the tip of the iceberg? Ceylon J Med Sci 2018. DOI:10.4038/cjms.v55i2.4941.

8        Wijerathne BTB, Rathnayake GK, Adikari SC, Amarasinghe S, Abhayarathna PL, Jayasena AS. Sexual dimorphism in digital dermatoglyphic traits among Sinhalese people in Sri Lanka. J Physiol Anthropol 2013; 32: 27.

9        Wijerathne BT, Rathnayake GK. Association between digital dermatoglyphics and handedness among Sinhalese in Sri Lanka. F1000Research 2013; 2: 111.