Kidney diseases encountered in tropical areas are a mix of conditions that have a worldwide distribution and those that are secondary to factors unique to the tropics (e.g. climatic conditions, infectious agents, nephrotoxic plants, envenomations, and chemical toxins). Cultural factors, illiteracy, superstitions, living conditions, level of access to health care, and nutritional status also affect the nature and course of disease. Knowledge of such conditions and issues is important for medical professionals in all parts of the globe, as ease of travel means that individuals and practices are exported with increasing frequency. Glomerular diseases—there is a high prevalence of infection-related glomerulonephritis (e.g. quartan malarial, schistosomal, and filarial nephropathies) throughout the tropics, with the pattern of injury dependent upon the nature of the prevalent endemic infection in that region. Once established, the course of disease is rarely modified by treatment of underlying infection. Acute kidney injury (AKI)—there is a higher prevalence of community-acquired AKI in the tropics than elsewhere. Medical causes predominate, with diarrhoeal diseases, intravascular haemolysis due to glucose-6-phosphate dehydrogenase deficiency, ingestion of toxic plants, snake bites, insect stings, and locally prevalent infections being responsible for most cases. Falciparum malaria and leptospirosis are the most important infectious aetiologies. Use of indigenous herbs and chemicals by traditional healers (‘witch doctors’) are the most important toxic causes of AKI in sub-Saharan Africa. Chronic kidney disease (CKD)—although the contributions of diabetes and hypertension are growing, many cases are secondary to glomerular diseases, likely infection related, or have CKD of undetermined aetiology. Many of the latter are agriculture or farm workers presenting with chronic tubulointerstitial nephritis of unknown cause.
