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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 4  |  Page : 674
Hyponatremia, rhabdomyolysis and acute kidney injury

Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India

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Date of Web Publication8-Jul-2009

How to cite this article:
Gupta A, Khaira A, Tiwari SC. Hyponatremia, rhabdomyolysis and acute kidney injury. Saudi J Kidney Dis Transpl 2009;20:674

How to cite this URL:
Gupta A, Khaira A, Tiwari SC. Hyponatremia, rhabdomyolysis and acute kidney injury. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2021 Jan 20];20:674. Available from: https://www.sjkdt.org/text.asp?2009/20/4/674/53302
To the Editor,

Rhabdomyolysis is a well known cause of acute kidney injury (AKI) and has been reported in various settings. [1] The population at high risk of AKI includes patients admitted in ICU, diabe­tics, elderly, and patients undergoing proce­dures requiring contrasts. [2] There is a subset of Indian population known as Kawariya who are at high risk for Rhabdomyolysis and subsequent acute kidney injury as a result of unaccustomed exercise due to firm religious beliefs. About a million Kawars (followers of Hindu Lord Shiva) walk about 40-50 kilometers/day barefoot in the Indian tropical weather for a period of 25-30 days to reach the holy Ganges river and collect water from it. They then walk back to their res­pective villages. This population predominantly comprises of young healthy adults. During the entire journey the Kawars consume a lot of salt free water and eat only limited amount of salt free food. This places them at high risk hypo­natremia which itself is a risk factor for deve­lopment of Rhabdomyolysis. [3] ,[4] ,[5]

We recently admitted 2 such cases of unaccus­tomed exercise and electrolyte disturbances lea­ding to rhabdomyolysis induced acute kidney injury in this population. Both the patients needed dialytic support and recovered over a period of 4 weeks. However at the time of discharge even after being counseled both were keen to follow the tradition again next year.

Although these cases are not uncommon in our country, the problem has been overlooked. We would conclude by saying that the Kawars Indian population is at high risk for hypona­tremia due to low salt water intake and may predispose to rhabdomyolysis.

   References Top

1.Sauret JM, Marinides G, Wang GK. Rhabdo­myolysis. Am Fam Physician 2002;65 (5):907­12.  Back to cited text no. 1    
2.Santoro A, Mancini E. Epidemiology of acute renal failure. J Ital Nefrol 2006; 23:S3-12  Back to cited text no. 2    
3.Cronin RE. Psychogenic polydipsia with hypo­natremia: report of eleven cases. Am J Kidney Dis 1987;9(5):410-6.  Back to cited text no. 3    
4.Putterman C, Levy L, Rubinger D. Transient exercise-induced water intoxication and rhabdo­myolysis. Am J Kidney Dis 1993;21(2):206-9.  Back to cited text no. 4    
5.Chawla S, Asmar A, Smith CA. Rhabdomyo­lysis: a lesson on the perils of exercising and drinking Am J Emerg Med 2008; 26(4):521.e3­4.  Back to cited text no. 5    

Correspondence Address:
Ankur Gupta
Department of Nephrology, All India Institute of Medical Sciences, New Delhi
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PMID: 19587518

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