Does alcohol consumption cause kidney disease?

Nephrologists typically would question you about your alcohol intake as part of a routine office visit.  Let's see why is that so? Humanity's association with alcohol dates back to antiquity, as evidenced by the now-famous discovery of the Stone Age Beer Jugs! So for millenia, we have been using alcohol variously as a medication, an antidote, a source of inspiration for treatment of writer's block, a medium to make friends and political connections, etc. "I have taken more out of alcohol than alcohol has taken out of me", claimed Winston Churchill. I am not sure if that included kidney disease or not, but I do intend to explore that question today. 

Does alcohol cause kidney disease?
Image courtesy of arztsamui/FreeDigitalPhotos.net

You would think that 9000 years of binge drinking would lead to some solid evidence about the association between alcohol use and kidney disease. Surprisingly, there are not a lot many good studies out there that have addressed this question.
There has been evidence to suggest that moderate alcohol consumption (less than 3 drinks/day for men, and less than 2 for women) is associated with a reduced risk of death, as compared to abstainers. Surprisingly, this holds true both for people with and without risk factors for cardiovascular disease (diabetes, hypertension, previous coronary heart disease)! This could be related to the ability of alcohol to boost good cholesterol (HDL) levels, increase insulin sensitivity, and alcohol's anti-thrombotic and anti-inflammatory action. This undoubtedly needs to be balanced against the risks of alcohol intake like cancers, accidental injuries, liver disease, etc. Hence, it is left to the individual patient and physician to weigh the risks and the benefits. At this time, the American Heart Association (AHA) does not recommend the initiation of drinking alcohol solely for its apparent cardiovascular benefits.

Some of the best evidence we have available to answer this question comes from the Physicians' Health Study. This study involved 11,023 initially healthy men and found that over a period of 14 years, greater consumption of alcohol was associated with a decreased risk of kidney disease! Other studies however reported no net benefit/harm.

Please be aware that the above evidence pertains to regular store-bought standardized liquor, and not to home distilled moonshine, which could be significant source of lead. This exposure is known to cause kidney disease, an entity called "lead nephropathy".

Here's my take home message. If you already drink a moderate amount of alcohol, you are probably going to be ok as far as your kidney function goes. You might even be reducing your risk of kidney disease. If you are not an alcohol drinker, starting solely to reduce the chance of kidney disease may or may not be an effective strategy. As I mentioned above, the AHA certainly does not recommend that. In that situation, talk to your doctor and go over your other disease comorbities and decide on the best approach. Last but not the least, stay away from moonshine!


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