Vibriosis-Induced Chronic Kidney Disease

Vibriosis-associated acute kidney injury (AKI) is a severe complication of infections caused by Vibrio species, a group of Gram-negative bacteria naturally present in marine and estuarine environments. Important human pathogens include Vibrio vulnificus, Vibrio parahaemolyticus, and Vibrio cholerae. Infection typically occurs through ingestion of contaminated seafood, especially raw oysters, or through exposure of wounds to seawater containing these organisms. While many infections remain limited to gastroenteritis, severe cases may progress to bloodstream infection, septic shock, and multi-organ failure, including Acute Kidney Injury.

Acute Kidney Injury develops when the kidneys suddenly lose their ability to maintain normal filtration and fluid balance. In severe vibriosis, several mechanisms contribute to renal damage[1]. Septic shock can reduce blood flow to the kidneys, producing ischaemic injury. Bacterial toxins and inflammatory mediators may damage renal blood vessels and tubular cells, while dehydration caused by diarrhoea and vomiting further decreases kidney perfusion[2]. Additional complications such as muscle breakdown (rhabdomyolysis), coagulation abnormalities, and systemic inflammation can accelerate kidney dysfunction.

Climate and environmental conditions, such as volcanic eruptions, can influence Vibrio ecology. Vibrio cholerae and other marine vibrios respond strongly to factors such as water temperature, salinity, nutrient availability, and plankton populations. Warmer coastal waters and changing aquatic conditions can increase bacterial abundance and expand the geographic range where infections occur. These environmental influences are increasingly relevant today as climate variability and ocean warming alter patterns of seafood-associated and waterborne infections.

Individuals at highest risk for severe vibriosis and Acute Kidney Injury include those with chronic liver disease, diabetes, kidney disease, iron overload disorders, cancer, or weakened immune systems. Elderly patients are also more vulnerable because of reduced physiological reserve.

Treatment requires immediate supportive care, including intravenous fluids to restore kidney perfusion, appropriate antibiotic therapy, and management of septic shock when present. Severe Acute Kidney Injury may require renal replacement therapy such as dialysis. Prevention remains critical and includes avoiding raw seafood, protecting wounds from seawater exposure, and seeking urgent medical care for rapidly progressive infections.

Most patients with vibriosis-related Acute Kidney Injury (especially from Vibrio cholerae) recover kidney function completely if they receive timely fluid resuscitation, antibiotics, and supportive care. However, severe or prolonged Acute Kidney Injury increases the risk of progression to Chronic Kidney Disease, consistent with the well-established link between Acute Kidney Injury and subsequent Chronic Kidney Disease in general.

In a retrospective study of post-diarrhoeal Acute Kidney Injury during a monsoon epidemic (including some confirmed Vibrio cases), approximately 8 to 15% of patients (8 out of ~87 with follow-up) developed persistent renal dysfunction at 3 months and were diagnosed with Chronic Kidney Disease[3].

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

[1] Qasem, Rabbani: Acute Kidney Injury Associated With Cholera in Cureus – 2023. See here.
[2] Vakrani, Nambakam: Retrospective Study on Acute Kidney Injury among Cholera Patients in an Outbreak in Whitefield, Bengaluru in International Journal of Nephrology – 2021. See here.
[3] Haridas et al: Post-Diarrheal Acute Kidney Injury During an Epidemic in Monsoon – A Retrospective Study from a Tertiary Care Hospital in Indian Journal of Nephrology – 2024. See here.