Arsenic-Induced Chronic Kidney Disease

From reading Agatha Christie's mysteries you will probably know that arsenic poisoning occurs over a brief period, symptoms may include vomiting, abdominal pain, encephalopathy, and watery diarrhoea that contains blood[1]. Chronic exposure can result in thickening of the skin, darker skin, abdominal pain, diarrhoea, heart disease, numbness, and cancer.

Ah, you might think, arsenic poisoning is a thing of the past, when (mostly) female murderers were using rat poison to get rid of the philandering husbands. Not so.

Inorganic arsenic (as opposed to the less poisonous organic arsenic) is naturally present at high levels in the groundwater of a number of countries, including Argentina, Bangladesh, Cambodia, Chile, China, India, Mexico, Pakistan, the USA, and Vietnam. Drinking water, crops irrigated with contaminated water, and food prepared with contaminated water are sources of exposure. Thus, arsenic poisoning is still a global health problem affecting many millions of people [Source: Fact sheet WHO].

Additionally, you can get poisoned from mining and other industrial processes where arsenic is inadvertently inhaled or ingested.

People who smoke tobacco can also be exposed to the natural inorganic arsenic content of tobacco because tobacco plants can take up arsenic that is naturally present in the soil.

Arsenic is also present as a contaminant in many traditional remedies.

Arsenic exerts its toxicity by inactivating up to 200 enzymes, especially those involved in cellular energy pathways and DNA synthesis and repair.

There are no evidence based treatment regimens to treat chronic arsenic poisoning.

A systematic review of the recent literature suggests evidence that exposure to arsenic may be associated with Chronic Kidney Disease[2]. Studies of arsenic exposure were mixed, but the highest quality studies reported negative impacts of arsenic on kidney function and Chronic Kidney Disease incidence.

We propose to call this Chronic Kidney Disease of non-Traditional causes (CKDnT): Arsenic-Induced Chronic Kidney Disease.

[1] Ratnaike: Acute and chronic arsenic toxicity in Postgraduate Medical Journal – 2003. See here.
[2] Moody et al: Toxic metals and chronic kidney disease: A systematic review of recent literature in Current Environmental Health Reports – 2019. See here.