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Environmental pollution and kidney diseases

Key Points

  • Up to 22% of the global burden of disease and 23% of deaths are attributable to environmental pollution; the general public is inevitably exposed to environmental pollutants

  • The kidney is particularly vulnerable to toxic effects from environmental pollutants owing to its filtration functions; environmental and occupational exposures to pollutants remain common causes of kidney disease worldwide, especially in developing countries

  • Long-term exposure to particulate matter <2.5 μm in mean aerodynamic diameter (PM2.5) is associated with increased risk of membranous nephropathy and more rapid decline in renal function

  • Exposure to heavy metals leads to acute and chronic kidney injury; tubular dysfunction is the most common manifestation of nephrotoxicity from heavy metals

  • Owing to the worldwide distribution of Aristolochia spp. and the still widespread use of medicinal herbal remedies containing aristolochic acids, especially in east Asia, it is possible that aristolochic acids might be the cause of unrecognized nephropathies

  • Exposure to industrial and agricultural chemicals, biogenic toxins and secondhand smoke are additional risk factors for kidney disease

Abstract

The burden of disease and death attributable to environmental pollution is becoming a public health challenge worldwide, especially in developing countries. The kidney is vulnerable to environmental pollutants because most environmental toxins are concentrated by the kidney during filtration. Given the high mortality and morbidity of kidney disease, environmental risk factors and their effect on kidney disease need to be identified. In this Review, we highlight epidemiological evidence for the association between kidney disease and environmental pollutants, including air pollution, heavy metal pollution and other environmental risk factors. We discuss the potential biological mechanisms that link exposure to environmental pollutants to kidney damage and emphasize the contribution of environmental pollution to kidney disease. Regulatory efforts should be made to control environmental pollution and limit individual exposure to preventable or avoidable environmental risk. Population studies with accurate quantification of environmental exposure in polluted regions, particularly in developing countries, might aid our understanding of the dose–response relationship between pollutants and kidney diseases.

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Figure 1: Worldwide distribution of disease burden attributable to environmental risks in 2012.
Figure 2: Size classification of particulate matter.
Figure 3: Potential mechanisms linking inhaled particles to pulmonary, cardiovascular, cerebral and kidney diseases.

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Acknowledgements

The authors are supported by the National Key Technology Support Program of China (2013BAI09B06 and 2015BAI12B07 to F.F.H.), the National Natural Science Foundation of China (81770683 to X.X.), the National Natural Science Foundation of China (Key Program) (81430016 to F.F.H.), the Major Scientific and Technological Planning Project of Guangzhou (201504010027 to F.F.H.) and the Major International (Regional) Joint Research Project (81620108003 to F.F.H.).

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Xu, X., Nie, S., Ding, H. et al. Environmental pollution and kidney diseases. Nat Rev Nephrol 14, 313–324 (2018). https://doi.org/10.1038/nrneph.2018.11

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