How air pollution can cause kidney disease

In November 2024, Sunita Bhosale woke up at 5:00 a.m. in excruciating pain. After Bhosale, 54, made her way to a local hospital, a doctor administered painkiller injections and intravenous drips and told her that she had a 6mm stone in her right kidney. “I will never forget that pain,” she says with tears in her eyes.

A kidney stone is a hard object that forms from minerals and other chemicals in the urine. Bhosale has been dealing with kidney stones for the past 4 years, but the pain, she says, had never been so severe. Determined to understand her worsening health, Bhosale started noting the times when she felt sick. It turned out that her symptoms worsened in the mornings and evenings. Curious, she began observing her surroundings, wondering if something in the environment around her home in Haroli, a village in India’s Maharashtra state, was making it worse.

“Every morning, almost everyone in the neighborhood burns a lot of wood, plastic seedling trays, and everything considered waste, to boil water for bathing,” Bhosale says. This smoke drifts into her house, leading to her coughing and frequent kidney stone pain in the lower back or abdomen. In the evenings, smoke from the burning of sugarcane residue in nearby fields seems to aggravate her condition.

While Bhosale knew that air pollution harmed the lungs, she wondered if it also affected her kidneys. She later shared her observations with a local doctor, who confirmed her suspicions. Toxic air was likely aggravating her kidney condition, the doctor said. In rural regions like Haroli, where kidney disease often goes undiagnosed, this exposure is silently adding to the burden.

The impact of air pollution on the kidneys is an emerging area of research. Scientists are now identifying which pollutants cause specific kidney damage.

How air pollution worsens kidney health

According to work by three kidney health societies—the American Society of Nephrology, European Renal Association–European Dialysis and Transplant Association, and International Society of Nephrology—850 million people across the globe have kidney diseases, and most of these people reside in low- and middle-income countries.

According to the National Kidney Foundation, several factors, such as not drinking enough water, eating food with excessive salt or sugar, and certain infections, can cause kidney stones. But when scientists from China examined 419,835 UK Biobank participants across 12.7 years, they also found an association between air pollution and kidney stone disease (J. Exposure Sci. Environ. Epidemiol. 2024, DOI: 10.1038/s41370-024-00728-0).

In an email, two of the study’s authors, Jinbo Chen and Minghui Liu, who are urologists at Xiangya Hospital, part of China’s Central South University, explain that air pollutants such as small particulate matter with a diameter of 2.5 µm or less (PM_2.5) and nitrogen dioxide (NO₂) can increase the risk of kidney stone disease through several biological pathways.

For example, PM_2.5 can penetrate deep into the lungs, cross into the bloodstream, and eventually reach the kidneys, where the particles trigger oxidative stress, Chen says. This process causes an imbalance between free radicals and antioxidants that can impair kidney function. “Specifically, it may disrupt proteins like Tamm-Horsfall protein that normally prevent crystal formation, leading to the growth of calcium oxalate stones, a common type of kidney stone,” he says.

Pollutants also activate the immune system, he says, causing chronic low-level inflammation. This persistent inflammation harms kidney tissues, making it easier for crystals to build up and form kidney stones.

Chen also says that air pollution harms blood vessels, including the tiny ones in the kidneys, which can reduce blood flow there and change urine’s concentration and acidity. Such changes can make it harder for the kidneys to keep minerals balanced, indirectly increasing the chance of forming kidney stones.

According to a study of data in the Global Burden of Disease database, more than 115 million cases of acute urolithiasis occurred globally in 2019 (Clin. Epidemiol. 2022, DOI: 10.2147/CLEP.S370591). These stones in the kidneys and elsewhere in the urinary tract can cause sudden, intense plain and block urine flow, which often requires urgent medical intervention and in 2019 led to over 13,000 deaths. Air pollution can exacerbate this.

From chronic illness to kidney failure

Multiple studies published this year have linked air pollution and kidney disease. In a study published in March, scientists investigated the long-term effects of air pollution in communities near petrochemical industry sites such as refineries in Nigeria. High concentrations of PM2.5, particulate matter with a diameter of 10 µm or less (PM₁₀), and volatile organic compounds were all linked to chronic kidney disease (BMJ Open 2024, DOI: 10.1136/bmjopen-2024-096336).

Ogochukwu Okoye, a nephrologist and professor at Delta State University in Nigeria who was part of that study’s research team, says, “PM_2.5 and PM₁₀ have been consistently shown to be associated with kidney damage.”

In the same month, researchers in China reported that long-term exposure to air pollution can elevate uric acid levels and increase the risk of kidney dysfunction (Sci. Rep. 2025, DOI: 10.1038/s41598-025-95204-6). And a separate group’s work indicated that PM_2.5, PM_2.5–10, NO₂, and carbon monoxide are associated with the exacerbation of kidney failure, with NO₂ having the most severe impact (J. Hazard. Mater. 2025, DOI: 10.1016/j.jhazmat.2024.136834).

Alongside vehicle and industrial emissions, burning crop residue is another source of air pollution. India produces about 500 million metric tons (t) of crop residue annually, 100 million t of which is burned. This burning has been linked to 44,000–98,000 premature deaths in the country each year between 2003 and 2019.

The health impacts of this pollution are increasingly visible in rural farming communities. In December 2024, 40-year-old Noor Ali Makandar from Maharashtra’s Rajapur village died from acute kidney injury (AKI). “He had no symptoms a year ago,” community health-care worker Noushadbi Mujawar says. “But with constant exposure to smoke from burning sugarcane residue, he began feeling unwell and frequently dizzy.”

Despite treatment, Makandar’s health declined. A nephrologist confirmed kidney failure. Within months, both kidneys stopped functioning. Makandar, who had been farming his 1-acre (4,000 m²) plot since childhood, had been frequently exposed to air pollution. “Nearly every sugarcane farmer burns residue,” says his mother, Dilshadbhi Mujawar, who has pollution-induced hypertension and diabetes.

Makandar’s story is not an isolated one. Emerging research from across the world points to a troubling link between air pollution and kidney damage, especially among those with long-term exposure. In a study of 313,908 people from the UK Biobank across 12.9 years, researchers found that coexposure to multiple air pollutants increased the risk of chronic kidney disease (CKD) (Ecotoxicol. Environ. Saf. 2025, DOI: 10.1016/j.ecoenv.2024.117582).

Chen and his colleagues have found that prolonged exposure to PM_2.5, PM₁₀, NO₂, and nitrogen oxides significantly increase the incidence of AKI and risk of death from it (BMC Public Health 2024, DOI: 10.1186/s12889-024-20321-2). “This suggests that air pollution doesn’t just trigger AKI but can worsen its outcomes, possibly by amplifying inflammation or kidney damage,” Chen says.

That study also shows that breathing polluted air can worsen CKD. Pollutants in the air can trigger repeated episodes of sudden kidney problems, like the kind of sharp pain and discomfort Bhosale feels during smoky mornings and evenings. Over time, this damages the kidneys’ ability to filter waste. As kidney function gets worse, CKD can progress to kidney failure, where the kidneys stop working, and a person may need dialysis or a transplant.

Tackling the problem

Chen and his colleagues found that living near green space lowers the risk of kidney stone disease. “Green spaces reduce local PM_2.5 and NO₂ levels, likely by filtering pollutants, offering a protective effect. So choosing to live in greener areas or advocating for more urban parks can help,” Chen says.

He also suggests general measures such as drinking plenty of water and limiting the intake of high-oxalate foods like spinach or nuts, steps that help lower the baseline risk of kidney stone formation.

Another option in well-resourced settings is indoor high-efficiency particulate air (HEPA) filters. These filters can trap PM_2.5 and other particles, reducing exposure when outdoor air quality is bad. Good ventilation with filtered air is also helpful.

Okoye suggests that educating people about the impacts of air pollution can prompt positive behavioral changes. “Simple interventions like providing continuous air monitoring data and information transparency will foster public awareness and concern, which might stimulate action. We have shown how portable and relatively cheap devices can be deployed in communities to achieve air monitoring,” she says.

With no access to air quality data, Bhosale needed 6 months of observations to connect the dots between air pollution and her kidney problems. But now she has started cultivating trees and plants near her house, hoping that it might help reduce the pollution levels.

In thousands of villages like Haroli, where the air is thick with smoke, many health burdens are borne in silence. Bhosale’s asking questions and raising awareness about the hidden impacts of air pollution. “I hope my suffering becomes a starting point to protect others from this invisible threat,” she says.

Sanket Jain is a journalist and documentary photographer from Maharashtra, India.