Beyond diabetes and high blood pressure: 7 lesser-known risk factors for kidney disease that often go unnoticed

Kidney disease rarely announces itself loudly. It builds slowly, often without pain, and reduces kidney function over years. Chronic Kidney Disease (CKD) affects nearly 10% of the global population.

Many people associate it only with diabetes and high blood pressure. These are indeed the leading causes. But they are not the full story.Dr Mohammed S. Khan, Associate Consultant, Department of Nephrology, KIMSHEALTH, Thiruvananthapuram, told TOI Health, “Chronic Kidney Disease (CKD) affects 10% of the population worldwide and is driven mainly by the ‘Big two’ villains—diabetes and blood pressure. However, the global kidney diseases crisis forces us to look beyond the usual suspects onto the emerging threats caused by environment, lifestyle and genetics.”Dr Gireesh M. S., HOD & Consultant, Department of Nephrology, Ramaiah Memorial Hospital, adds, “According to studies, nearly one in four adults may have some degree of chronic kidney disease. This does not necessarily mean complete kidney failure, but it does indicate that kidney function is already compromised in a significant portion of the population.”Here are 7 lesser-known but critical risk factors that deserve more attention.

Obesity: More than a diabetes risk

Obesity does not just lead to diabetes. It can directly injure the kidneys.When body weight increases, kidneys must work harder to filter blood. This “overwork” causes hyperfiltration. Over time, it scars kidney tissue and reduces filtering ability. Younger adults now show early signs of kidney stress linked to obesity.Dr Khan notes, “Rather than just a precursor to diabetes, obesity directly harms the kidneys.

Kidneys struggle to overwork, eventually get scarred and fail to filter properly.”The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), under the US National Institutes of Health, also confirms that obesity increases the risk of CKD through direct and indirect pathways. Their research highlights weight control as a protective factor.Sedentary habits, high-calorie diets, and sugary beverages make the damage worse. The solution is simple but not easy: steady weight reduction, daily movement, and balanced meals.

Smoking: A silent accelerator

Smoking does not just harm lungs and heart. It damages blood vessels, including those inside the kidneys.Nicotine reduces blood flow to kidney tissue. Toxins in cigarette smoke promote inflammation and scarring. In people who already have kidney disease, smoking speeds up progression.Dr Khan puts it simply: “Smoking can choke your kidneys and speeds up renal damage.”The US Centers for Disease Control and Prevention (CDC) also links smoking to faster kidney function decline. Quitting smoking slows down kidney damage, even in those already diagnosed.

The mystery of CKDu in rural hotspots

One of the most concerning trends is Chronic Kidney Disease of Unknown Etiology (CKDu).Dr. Khan explains, “Various studies have pointed towards another emerging endemic renal disease called Chronic Kidney Disease of Unknown Etiology (CKDu). Initially identified as ‘Mesoamerican nephropathy’, now ranges to many newly identified hotspots worldwide including regions in India like Andhra Pradesh, Telangana (Uddhanam), Odisha, Goa, Maharashtra, Chhattisgarh, Kerala (Kozhikode).”Unlike traditional CKD, CKDu often affects young farmers and labourers without diabetes or hypertension. Possible triggers include repeated dehydration, heat stress, agrochemical exposure, and heavy metals in water.Dr Khan adds, “Regular testing at hotspots can help in early detection as well as to slow progression of disease.”Early screening camps in such areas have shown that many cases can be detected before severe damage occurs.

Painkillers and “natural” medicines

Over-the-counter painkillers, especially NSAIDs, can quietly injure the kidneys if taken frequently.Dr Khan warns, “Frequent use of over the counter (OTC) pain killers, especially NSAIDs when taken regularly for headache or joint pain can permanently damage the kidneys.”Dr Gireesh M. S. reinforces this concern: “Prolonged use of painkillers without medical supervision can significantly impair kidney function.

The damage may occur gradually and remain unnoticed for a long time.”The National Kidney Foundation (US) also cautions against long-term NSAID use in people with kidney risk factors.The “natural” label can also mislead. Dr Khan explains, “Behind the ‘natural’ label hides the undisclosed contents in many traditional and indigenous medications and it plays a part in kidney injury.”Heavy metal contamination and unsafe dosages have been reported in some unregulated preparations.

Long-term unsupervised use increases risk.

Supplements for muscle and weight loss

Fitness culture has normalised supplement use. But not all products are safe.Dr Gireesh says, “The growing use of supplements for bodybuilding or weight loss, particularly those taken without prescription, poses another emerging risk.”High-protein supplements, creatine misuse, and fat-burning compounds may stress kidneys, especially in people with undiagnosed kidney problems.

Some products also contain undeclared substances.The US Food and Drug Administration (FDA) has issued warnings about certain bodybuilding supplements linked to kidney injury. Caution and medical guidance matter more than marketing promises.

Recurrent infections and kidney stones

Repeated urinary tract infections (UTIs) can spread upward and scar the kidneys.Dr Gireesh notes, “Recurrent urinary tract infections, untreated or frequent kidney stones, and a family history of kidney disease can all contribute to the development and progression of CKD.”Kidney stones also cause repeated obstruction and inflammation. Over time, this can permanently damage kidney tissue. Ignoring recurring symptoms allows silent injury to continue.

Genetics and autoimmune diseases

Family history is not just a background detail. It can be central.Dr Khan states, “Genetic diseases contribute to 20–25% of CKD.” Many genetic conditions present as early or stubborn high blood pressure.Autoimmune diseases such as systemic lupus erythematosus can directly attack kidney filters.

Dr Gireesh explains, “Autoimmune diseases must also be considered. Conditions such as Systemic lupus erythematosus and other systemic autoimmune disorders can directly affect the kidneys and lead to chronic kidney damage.”Simple blood and urine tests can detect early damage, even before symptoms appear.

The silent nature of kidney disease

Kidney disease progresses without obvious warning signs. There may be no pain, no fever, and no dramatic symptom.Dr Gireesh concludes, “The most important step in protecting kidney health is regular health check-ups. Early detection allows us to intervene promptly and prevent further progression of the disease.”Regular screening becomes crucial for those with obesity, family history, frequent painkiller use, or occupational exposure.Medical experts consulted This article includes expert inputs shared with TOI Health by: Dr Mohammed S. Khan, Associate Consultant, Department of Nephrology, KIMSHEALTH, Thiruvananthapuram.Dr Gireesh M. S., HOD & Consultant, Department of Nephrology, Ramaiah Memorial Hospital.Inputs were used to explain some unnoticed risk factors that can lead to kidney disease.