Unregulated herbal medicines and delayed diagnosis are emerging as major risk factors.

Hyderabad: A chronic kidney ailment of mysterious origin, known as Chronic Kidney Disease of unknown etiology (CKDu), is causing kidney failures in Hyderabad and surrounding districts of Telangana, disturbingly among younger and economically productive individuals who have no history of diabetes and hypertension.

Senior nephrologists from Osmania General Hospital (OGH) and Apollo Hospitals led a study of 75 patients and published the results in the prestigious Indian Journal of Nephrology (August, 2024). Their findings indicate that the ailment is similar to the mysterious kidney failures taking place in Andhra Pradesh and other Indian States, but with a unique city-based risk profile.

"Our study documents the presence of CKDu phenotype in Telangana, outside the well-known hotspots. Agricultural background isn't a necessity for the development of CKDu," the study, which was led by Head of Nephrology, OGH, Dr Manisha Sahay, said.

While CKDu elsewhere is traditionally linked to strenuous agricultural labor and heat stress, the OGH clinical data strongly suggest that distinct, non-occupational risk factors are driving the disease among the younger, economically productive populations with no agricultural background.

The disease is characterized by a silent progression, often only manifesting symptoms once the kidneys are catastrophically damaged, necessitating immediate care at facilities like Osmania General Hospital (OGH).

The OGH study revealed stark differences compared to global CKDu clusters, offering a clear direction for public health officials in Telangana.

"Globally, agricultural laborers constitute 60 to 80 percent of CKDu cases but the Hyderabad cohort reported only 21.3 percent of patients involved in rice farming. This confirms that the CKDu phenotype exists significantly in people from diverse, non-agricultural backgrounds, including small business owners, service workers, and city residents," Dr Manisha Sahay in the study said.

Compounding this, a staggering 40 percent of CKDu patients in the OGH study reported a history of consuming unregulated alternate or herbal medicines.

Researchers now highlight this prevalent local practice as a potentially causal risk factor that warrants urgent public health attention and investigation across local dispensaries and traditional remedy suppliers.

Finally, the kidney biopsy of OGH patients displayed extensive scarring and inflammation in the kidney's filtering units, confirming that the disease begins silently in this compartment.

"The damage seen in these biopsies underscores the catastrophe of late presentation, a consistent feature in all CKDu regions. Because the disease is initially asymptomatic, patients often present to city hospitals only when they require immediate dialysis or renal replacement therapy," Dr Sahay said.