What Is Causing a Surge in Kidney Failure Cases in Telangana?

Source: The Hindu

Relevance: GS Paper–I: General Essay Social Issues Unregulated alternative medicine, quackery, public health crisis

Important Key Concepts for Prelims and Mains:

For Prelims:

Chronic Kidney Disease of Unknown Aetiology (CKDu)

For Mains:

Public Health Regulation & Medical Ethics, Environmental & Groundwater Contaminants
Health System Burden & Catastrophic Expenditure

Why in News?

Hospitals across Telangana are reporting a sharp rise in kidney failure cases, particularly among young adults who lack traditional risk factors such as diabetes or hypertension. A recent study (2024) by Osmania General Hospital and Apollo Hospitals suggests a possible link to self-prescribed alternative medicines and widespread quackery, although a direct scientific association is yet to be proven.

Key Study Findings: The Osmania–Apollo Research (2021–2022)

Chronic Kidney Disease (CKD)
Definition
• CKD is a progressive and irreversible loss of kidney function over months to years.
• Kidneys normally filter waste, excess fluid, and electrolytes — removed as urine.
Cause & Progression
• Common causes: Diabetes, hypertension, glomerular diseases.
• But CKD can also occur without these factors (e.g., CKDu — CKD of Unknown Aetiology).
• Damage progresses even if the underlying cause is controlled.
Symptoms
• Early CKD: Often asymptomatic → diagnosed late.
• Advanced CKD: Accumulation of waste, fluids, toxins, leading to:
– Swelling
– Electrolyte imbalance
– Fatigue, nausea
– Reduced urine output
Stages of CKD
Classified based on GFR (Glomerular Filtration Rate):
• Stage 1–2: Mild
• Stage 3–4: Moderate to severe decline
• Stage 5: End-stage renal disease (ESRD) → requires dialysis or kidney transplant

The study examined 75 patients with chronic kidney disease of Unknown Aetiology (CKDu) in Telangana.

Demographic Highlights

Mean age: 41.7 years
Men: 68%
Groundwater consumption: 77.3%
Reported past use of alternative medicine: 40%
Kidney biopsies: 46.6%

Major Clinical Findings

44% showed global glomerulosclerosis — permanent scarring of kidney filters.
33% had hyperuricemia.
9.3% required immediate dialysis.

Researchers note that while a definite causal link is not yet proven, unregulated herbal/alternative medicines remain a strong hypothesis requiring deeper investigation.

Possible Causes Behind the Surge

1. Increasing Use of Unregulated Alternative Medicines

Doctors report that many affected patients consumed:

Powders, leaves, and liquids
Herbs supplied in unlabelled bottles
Substances recommended by quacks, neighbours, or friends
No dosage instructions, no medical supervision

Absence of samples makes toxicology verification difficult.

2. Quackery and Irrational Prescriptions

The Telangana Medical Council warns of rampant unsafe practices:

Use of dexamethasone + diclofenac injections for instant pain relief
Both drugs are known to cause direct nephron damage
Many rural patients do not know the risks and consider quick relief as “effective treatment”
Such combinations can accelerate kidney destruction within weeks or months

3. Drug Interactions & Metabolism Issues

Unqualified practitioners prescribe:

Medicines with unknown strength
Herbs that interact with standard treatments

Consequences include:

Slow metabolism → drug accumulation → kidney/liver toxicity
Fast metabolism → drug cleared too quickly → treatment failure
Potential damage to brain, liver, and kidneys

4. Environmental & Water Quality Factors

Over 77% depended on groundwater, which in some regions contains heavy metals, fluoride, or contaminants.
While not conclusively proven in this study, environmental toxins remain a potential risk factor.

Why These Cases Are Concerning

1. Young, Healthy People Are Affected

Unlike conventional CKD, this cluster involves adults with no diabetes or hypertension.

2. Late Presentation

Nearly 40% arrived only at Stage 5, when kidneys are severely damaged and options limited.

3. Economic & Social Impact

Kidney failure affects wage-earners, leading to:

Catastrophic health expenditure
Long-term dependence on dialysis
Burden on families and public hospitals

Conclusion

While the scientific basis is still emerging, the rise of kidney failure cases in Telangana highlights a dangerous intersection of unregulated alternative medicines, quackery, and late diagnosis.A robust public health response — combining regulation, awareness, clinical research, and enforcement — is crucial to protect communities and prevent a future health crisis.

CARE MCQ

Q. With reference to urine formation, consider the following statements:

Glomerular filtration occurs due to the high hydrostatic pressure in the glomerular capillaries.
About 1100–1200 ml of blood is filtered per minute by both kidneys.
Only 1/10th of the cardiac output is filtered through the kidneys per minute.

How many of the above statements are correct?

(a) Only one
(b) Only two
(c) All three
(d) None

Correct Answer: (b) Only two

Explanation:

Statement 1: Correct — Filtration is driven by glomerular blood pressure.
Statement 2: Correct — NCERT states 1100–1200 ml/min.
Statement 3: Incorrect — Kidneys filter 1/5th (~20%) of cardiac output, not 1/10th.