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Licensed Unlicensed Requires Authentication Published by De Gruyter December 6, 2021

“Failing kidneys in a failing planet; CKD of unknown origin”

  • Eleni Geladari , Natalia Vallianou EMAIL logo , Charalampia Geladari , Konstantinos Aronis , Konstantinos Vlachos , Emmanuel Andreadis , Ioannis Theocharopoulos and Spyros Dourakis


The ‘alarm clock’ for human beings in the era of climate medicine has rung. Original diseases have appeared, that could not be explained and attributed to common causes, which are suggested to be linked to global warming and environmental factors. Such an indolent disease is the chronic kidney disease of unknown cause (CKDu), introduced also as Mesoamerican or Uddanam nephropathy. Scientists equate the climate impact on kidneys with the canary in the coal mine; coal miners used to carry caged canaries with them, so that if poisonous gases, such as methane or carbon monoxide leaked into the mine-shaft, the gases would kill the canary before killing the miners; similarly, kidneys are injured before devastating and lethal complications occur in humans. In some regions of Central America, the deaths due to chronic kidney disease increased by 177% with a death toll being as high as over 20,000. It was first documented in animals that periodic heat and dehydration have a major role in causing chronic kidney disease. Based on that observation, it is advocated that young male agricultural workers in Central America and South Asia, develop renal disease by getting exposed to extreme heat repeatedly. The clinico-pathological characteristics of this type of kidney injury, do not belong to an existing classification, even though a form of tubulo-interstitial renal disease has been proposed. In this review, we will discuss about CKDu, its epidemiology and pathophysiological mechanisms, clinical presentation and diagnostic biomarkers and examine potential therapeutic options.

Corresponding author: Natalia Vallianou, Internal Medicine, Polykliniki, 3 Pireaus str, Athens, Greece, 105 52, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.


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Received: 2021-08-18
Accepted: 2021-11-22
Published Online: 2021-12-06
Published in Print: 2023-03-28

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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