Articles by Swati Sharma

Technology

The Silent Kidney Crisis

It doesn’t begin with pain or swelling. There are no warning signs — until it’s too late. By the time most patients are diagnosed, nearly 90% of their kidney function is already lost. A recent study by nephrologists at Osmania General Hospital (OGH) has revealed a worrying trend: a rise in Chronic Kidney Disease of Unknown Origin (CKDu) among younger, non-diabetic, urban residents. Once confined to rural belts, CKDu is now surfacing in Hyderabad’s hospitals — and doctors are calling it a silent epidemic. A Disease Without the Usual Suspects “CKDu occurs in people without the typical risk factors like diabetes, hypertension, or prior kidney disease,” explains Dr P.S. Vali, HOD-Nephrology and Senior Consultant at the Asian Institute of Nephrology and Urology (AINU). Unlike conventional chronic kidney disease that damages the glomeruli — the blood-filtering units of the kidneys — CKDu primarily injures the tubules, the microscopic ducts that carry urine. “In lab reports, we see high creatinine levels but very little protein in the urine — a hallmark of toxic injury,” says Dr. Vali. Kidney biopsies of CKDu patients, he adds, show tubulo-interstitial scarring, consistent with exposure to heavy metals, herbal toxins, or chemicals. “The cause is often environmental rather than lifestyle-related.” The Silent Progression CKDu advances quietly. “It’s asymptomatic in the early stages — no pain, no swelling, no obvious changes,” warns Dr Vali. Dr E. Ravi, Senior Consultant Nephrologist at KIMS Hospitals, adds, “In early disease, patients may only notice frequent urination at night or none at all. By the time creatinine levels rise or kidneys shrink on ultrasound, the damage is often irreversible.” Doctors say they’re now treating patients in their 30s and 40s with advanced kidney failure — a profile that was rare a decade ago. Environmental and Toxic Links Preliminary findings suggest that groundwater contamination, heavy metals, and unregulated herbal formulations may be driving the surge. “Substances like lead, mercury, or arsenic — often found in certain herbal or ‘detox’ products — can cause long-term tubular damage,” says Dr Vali. “People assume herbal means harmless, but that’s a dangerous myth.” Researchers note that similar CKDu clusters have been reported in Uddanam (Andhra Pradesh), Villupuram and Cuddalore (Tamil Nadu), Bargarh (Odisha), and parts of Maharashtra — all regions with documented exposure to agrochemicals and contaminated water. While Hyderabad’s outbreak is still under study, doctors say the city’s rapid industrialisation, polluted groundwater, and rising use of unregulated supplements are possible contributors. The Heat Factor Hyderabad’s rising temperatures add another layer of risk. “Prolonged heat exposure and chronic dehydration can repeatedly injure kidney tubules,” explains Dr Ravi. Those most vulnerable include construction workers, delivery riders, and outdoor labourers. “Not everyone who gets dehydrated will develop CKDu,” clarifies Dr Vali. “But when dehydration combines with toxic exposure and high heat — a ‘triple hit’ — the risk multiplies dramatically.” Who’s Most at Risk CKDu predominantly affects men aged 20 to 60, especially those engaged in manual or outdoor work. Unlike classic kidney disease, these patients typically have normal blood pressure, no diabetes, and no family history of renal disorders. “The clinical profile is distinct,” notes Dr Ravi. “Normal BP, bland urine, high creatinine, and small kidneys — that pattern should raise immediate suspicion.” Prevention Over Cure Since the exact trigger remains unclear, prevention and early screening are crucial. “Routine kidney tests — serum creatinine and eGFR — for high-risk individuals can catch early dysfunction,” says Dr Ravi. The Road Ahead Nephrologists are now pushing for comprehensive environmental studies to pinpoint causes and prevent further spread. “Urban doesn’t mean safe,” warns Dr Vali. “Pollution, poor water quality, and unregulated remedies are catching up fast.” CKDu’s rise is a wake-up call — not just for doctors, but for a city that that health begins with what we drink, breathe, and believe to be safe. CKDu in a Snapshot · Affects non-diabetic, non-hypertensive individuals · Damages tubules, not glomeruli · Causes high creatinine, minimal protein in urine · Linked to toxins, heat stress, dehydration, and herbal remedies · Silent onset, detected late · Preventable with hydration, safe water, and regular screening