Correspondence
R2 Syndrome: Religion and Renal Failure
Ankur Gupta1, Charanjit Lal1, Ambar Khaira1, Sanjay K Agarwal2, Suresh C Tiwari2
1Registrar, 2Professor, Department of Nephrology, All India Institute of Medical Sciences, New Delhi 110029, India
Received: 11.02.2009; Revised: 19.05.2009; Accepted: 21.05.2009
Sir,
Renal failure occurs in a variety of settings. Amongst causes prevalent in Indian subcontinent, religion plays a prime role. The different customs and religious activities bring diversity in modes of renal injury. We hereby describe the settings where religion plays a contributory etiology to renal failure.
The foremost cause is dehydration which occurs due to prolonged fasts especially those undertaken by Jains ( upvaas) and Muslims ( ramzan ) particularly in our tropical climate with heat and humidity. The custom of depriving food and water in order to please God and the current global warming set in events leading to pre-renal azotemia and renal dysfunction in this multi-religious society. This occurs more so in cases already at risk like diabetics, pregnancy and preexisting chronic kidney disease. The practice of feeding snakes on nag-panchmi, a religious ritual predisposes to snake bite induced acute kidney injury (AKI). This customary practice continues even after this well known risk of snake bite.1
Rhabdomyolysis is an important cause of renal failure. AKI occurs in 33-50% of patients with rhabdomyolysis.2 Walking barefoot long distances in tropical climates, yatras to take kawars for Lord Shiva predisposes them to volume depletion and electrolyte disturbances and consequent rhabdomyolysis and AKI. Stampedes and crush injuries occurring in overcrowded places of worship like haj and kumbh fair may also cause rhabdomyolysis and AKI. These overcrowded places also have high incidences of food poisonings, malaria, leptospirosis, viral hepatitis, cholera, typhoid and certain intoxications. All of these are potential causes of AKI. The practice of drinking holywater from mahasnans (holybath) from river Ganges and sangam is causal for acute gastroenteritis, sepsis and renal failure. The mad faith of bathing in selected ponds and magical activities by quacks leads to mismanagement of hepatic failure and predisposes to hepatorenal syndromes.
To conclude, the letter highlights blind customs and religious notions predisposing to acute renal failure. This association between religion and renal failure shall now be called as R² syndrome. Public awareness and public health measures need to be addressed. An effort needs to be put by medical readers to warn our population from ill effects of these religious customs. Then only, such causes of renal failure can be prevented and taken care of.
References
- Kanjanabuch T, Sitprija V. Snake bite nephrotoxicity in Asia. Semin Nephrol. 2008;28: 363-72.
- Lima RS, da Silva Junior GB, Liborio AB, Daher Ede F. Acute kidney injury due to rhabdomyolysis. Saudi J Kidney Dis Transpl. 2008;19: 721-9.
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