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Recent experimental work on the nephrotoxicity of contaminants in drinkingwater using laboratory mice, motivated by the need to understand the origin ofchronic kidney disease of unknown aetiology is examined within ourunderstanding of the hydration of ions and proteins. Qualitative considerationsbased on Hofmeister-type action of these ions, as well as quantitativeelectrochemical models for the Gibbs free-energy change for ion-pair formationare used to explain why Cd$^{2+}$ in the presence of F$^-$ and water hardnessdue to Mg$^{2+}$ ions (but not Ca$^{2+}$) can be expected to be morenephrotoxic, while AsO$_3^{3-}$ in the presence of F$^-$ and hardness may beexpected to be less nephrotoxic. The analysis is applied to a variety of ionicspecies typically found in water to predict their likely combinedelectro-chemical action. These results clarify the origins of chronic kidneydisease in the north-central province of Sri Lanka. The conclusion is furtherstrengthened by a study of the dietary load of Cd and As, where the dietaryloads are found to be safe, especially when the mitigating effects ofmicronutrient ionic forms of Zn and Se, as well as corrections forbio-availability are taken in to account. The resulting aetiological picturesupports the views that F$^-$, Cd$^{2+}$ (to a lesser extent), and Mg$^{2+}$ions found in stagnant household well water act together with enhancedtoxicity, becoming the most likely causative factor of the disease. Similarincidence of CKDu found in other tropical climates may have similar geologicalorigins.

Chronic Kidney Disease of Unknown aetiology (CKDu) and multiple-ion interactions in drinking water