Environmental Threats to Kidney Health: A Clinician's Guide to Modern Exposures

Individuals are increasingly exposed to a diverse array of chemicals through the environment, consumer products, and occupational settings. These exposures, often involving substances with unknown or emerging implications for human health, may pose significant kidney health risks because many are processed by the kidneys and excreted in the urine. Kidneys are particularly vulnerable to injury from inorganic chemicals such as lead, cadmium, and mercury. These originate from geogenic sources, but their exposures are multiplied by anthropogenic activities. Emerging data detail possible kidney risks from chemicals derived entirely from anthropogenic activities as well such as from per- and polyfluoroalkyl substances (PFAS), melamine, and agrochemicals. Chronic kidney disease resulting from these environmental exposures is likely underdiagnosed in clinical practice. This review describes the sources of exposure, systemic effects, and potential nephrotoxicity of implicated chemicals, aiming to increase the recognition of environmental exposures as contributors to unexplained new kidney disease. A thorough exposure history and specialized laboratory evaluation may be used for diagnosis in high-risk individuals. Increased clinical awareness and dedicated research efforts are essential to understand and mitigate environmental nephrotoxic exposures and protect kidney health.