Can skin-lightening creams harm the kidneys? Here’s what an expert says

Have you seen cases of kidney problems due to the use of skin-lightening creams?

We have seen a few cases of nephrotic syndrome, characterised by protein leakage in the urine, following the use of skin-lightening creams. But these were all creams lacking labels, brand names or information about their ingredients. Notably, these patients exhibited elevated blood mercury levels. This strongly suggests that these creams, likely untested and uncertified by regulatory agencies, contained mercury, which was absorbed through the skin upon application. Such cases are not confined to this region alone; similar incidents have been reported across various parts of the country and worldwide.

The most extensive series, linking skin-lightening cream usage to kidney ailments, particularly membranous nephropathy, has been documented in Kerala.

How can the kidneys be affected by these creams?

Some people may have an increased susceptibility to kidney damage, with uncertified creams acting as a trigger. A Kerala study last year confirmed their high mercury content. When mercury is absorbed through the skin, it reaches the kidneys and binds to specific components of the kidney’s filtration apparatus. This triggers the production of antibodies, which target the body’s own tissues and a protein present in the kidneys, against these filtration components. The resulting immune response causes damage, leading to protein leakage into the urine. If this protein loss is left unaddressed, it can cause further, potentially irreversible, kidney damage.

What are symptoms of protein leakage?

Swelling in the legs and body. There is protein loss, particularly of serum albumin—an essential protein. There is an increased risk of infections due to the loss of protective proteins in the urine and a heightened tendency for blood clot formation caused by the loss of specific coagulation-regulating proteins. Additionally, up to one-third of patients may develop elevated blood pressure.

What is the treatment protocol?

Discontinuing the cream leads to a significant reduction in urinary protein leakage in a majority of patients, as observed in my experience and from the series from Kerala. However, a small sub-set of patients may require immune-suppressive therapy to inhibit auto-antibody production and mitigate further kidney damage. Throughout this process, we also administer non-immunosuppressive medications, such as antihypertensive drugs and lipid-lowering agents, to further reduce urinary protein levels and support kidney health.