Across the military, firefighting, and industrial communities, a growing number of patients are being diagnosed with rare kidney diseases—including membranous nephropathy, FSGS, minimal change disease, and nephrotic syndrome—years after exposure to high-toxicity combustion environments.
Until recently, these toxic exposures were rarely connected to long-term renal injury. Today, that picture is changing.

 

What We Now Know: Toxic Smoke Is Not “Just Smoke”

Large fires—whether shipboard, structural, industrial, or involving petroleum products—release complex mixtures of polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), heavy metals, and ultra fine particulates. These chemicals travel deep into the lungs and bloodstream and are now recognized for their potential to cause:

• Immune dysregulation

• Podocyte injury

• Glomerular inflammation

• Persistent proteinuria

• Long-term organ damage

 

Why This Matters for Rare Kidney Disease

Rare glomerular diseases are often autoimmune or immune-mediated. Many of the chemicals released in military and industrial fires—specifically PAHs—have been shown to:

• Alter B-cell and T-cell function

• Trigger antibody-mediated injury

• Damage podocytes and filtration membranes

• Increase oxidative stress in renal tissue

These mechanisms mirror the pathological changes seen in diseases such as membranous nephropathy and nephrotic syndrome.

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Key Scientific Findings (Medical Professionals Can Cross-Verify)

 

1. PAH Exposure & Proteinuria

Key Point: Multiple studies demonstrate a dose-response relationship between urinary PAH metabolites and albuminuria — an early sign of glomerular injury.

• Xu X. et al. Environmental Science & Technology. 2010.

• Rengarajan T. et al. International Journal of Environmental Research and Public Health. 2015.
  🔗 NIH Search Link: https://pubmed.ncbi.nlm.nih.gov/?term=PAH+proteinuria

 

2. PAH-Induced Podocyte Damage

Key Point: PAHs (including benzo[a]pyrene) directly injure podocytes — the filtration cells whose damage leads to nephrotic syndrome and progressive kidney disease.

• Ichimura T. et al. Toxicology and Applied Pharmacology. 2010.

• Arlt V.M. et al. Mutagenesis. 2016.
  🔗 NIH Search Link: https://pubmed.ncbi.nlm.nih.gov/?term=PAH+podocyte+injury

 

3. Immune Dysregulation From Combustion Chemicals

Key Point: PAHs alter immune pathways through AhR activation, promoting autoimmune patterns and dysregulated antibody production — mechanisms consistent with immune-mediated kidney disease.

• Esser C., Rannug A. Annual Review of Pharmacology and Toxicology. 2015.

• Winans B., Humble M.C. International Journal of Environmental Research and Public Health. 2011.
  🔗 NIH Search Link: https://pubmed.ncbi.nlm.nih.gov/?term=PAH+immune+regulation

 

4. Elevated PAH Biomarkers in Firefighters & Military Personnel

Key Point: Occupational studies show firefighters and service members experience significant spikes in PAH biomarkers after fire or combustion exposure — confirming meaningful absorption.

• Caux C., O’Brien C. Annals of Occupational Hygiene. 2002.

• Fent K.W. et al. Journal of Occupational and Environmental Hygiene. 2014.
  🔗 NIH Search Link: https://pubmed.ncbi.nlm.nih.gov/?term=firefighters+PAH+biomarkers

 

5. Delayed Onset of Toxic Exposure–Related Kidney Injury

Key Point: Immune-mediated diseases (including glomerulopathies) can manifest years after exposure, consistent with patterns seen in many military and industrial toxin cases.

• KDIGO Glomerular Disease Guidelines (2021).

• Perera F. et al. Environmental Health Perspectives. 2012.
  🔗 NIH Search Link: https://pubmed.ncbi.nlm.nih.gov/?term=PAH+long+term+immune

 

6. PFAS Exposure & Kidney Health (Emerging Evidence)

Key Point: PFAS, another major toxicant class relevant to DoD and VA cases, is increasingly linked to proteinuria, decreased kidney function, and kidney cancer.

• EFSA Panel on Contaminants. 2020.

• Sunderland E.M. et al. Environmental Health Perspectives. 2019.

• Steenland K. et al. Environmental Health. 2020.
  🔗 NIH Search Link: https://pubmed.ncbi.nlm.nih.gov/?term=PFAS+kidney

 

7. Federal Acknowledgment of Toxic Exposure Risks (VA & Congress)

 

a. VA Announcement: PFAS & Kidney Cancer Review (2024)

Key Point: VA formally announced it is reviewing PFAS exposure as a potential cause of service-connected kidney cancer.
🔗 https://news.va.gov/press-room/va-to-review-possible-service-connection-between-pfas-exposure-and-kidney-cancer/

 

b. Honoring Our PACT Act (2022)

Key Point: Establishes presumptive conditions and expanded benefits for toxic-exposed veterans.
🔗 https://www.va.gov/resources/the-pact-act-and-your-va-benefits/

 

c. VET PFAS Act — H.R. 3639 (Current Legislation)

Key Point: Would require VA to presume certain illnesses are caused by PFAS at contaminated bases — including many DoD installations.
🔗 https://www.congress.gov/bill/119th-congress/house-bill/3639

 

H.R. 3639

Introduced in House (05/29/2025)  Currently 23 co-sponsors

Veterans Exposed to Toxic PFAS Act or the VET PFAS Act

This bill provides eligibility for Department of Veterans Affairs (VA) hospital care and medical services to veterans and their family members (including those in utero) who have specified conditions and resided at a military installation where individuals were exposed to perfluoroalkyl and polyfluoroalkyl substances, commonly known as PFAS. PFAS are man-made and may have adverse human health effects.

Hospital care and medical services may not be furnished for a condition that is found to have resulted from a cause other than the exposure to PFAS at a military installation.

The VA may provide reimbursement for hospital care or medical services provided to a family member only after the family member or provider has exhausted all claims and remedies otherwise available for payment of such care.

For disability compensation purposes, the bill establishes a presumption of service-connection for specified conditions in veterans who served at a military installation at which individuals were exposed to PFAS. Under a presumption of service-connection, specific conditions diagnosed in certain veterans are presumed to have been caused by the circumstances of their military service. Health care benefits and disability compensation may then be awarded.

 

Why EKF Is Bringing Attention to This

The Enlisted Kidney Foundation works directly with veterans, first responders, shipboard personnel, and industrial workers who were never told that toxic exposures could be linked to rare kidney disease.
We are:

• Identifying patterns

• Reviewing exposure histories

• Analyzing toxicology research

• Connecting patients with medical teams

• Supporting claim development for VA and civilian cases

• Educating nephrologists and frontline clinicians on emerging evidence

We do not claim that every exposure causes kidney disease.
But we do assert that there is now enough scientific basis to justify deeper evaluation, especially for patients presenting with:

• Nephrotic-range proteinuria

• Membranous nephropathy

• FSGS

• Minimal change disease

• Chronic kidney inflammation

This topic has historically been under-recognized. We're helping change that.

 

The “Closing the Gap” Initiative

To support clinicians, researchers, and veteran advocates, EKF is launching a continuing project to:

1. Compile emerging scientific evidence

2. Break down exposure pathways

3. Improve early detection

4. Educate nephrologists and primary care teams

5. Support veterans navigating toxic-exposure claims

6. Advocate for national awareness and improved policy

Our goal is simple:
No kidney warrior should fall through the cracks because an exposure link was overlooked.

 

We Invite Medical Professionals to Contact Us

This field is rapidly evolving — and we are working with nephrologists, toxicologists, and researchers to expand the evidence base.

If you are a clinician, researcher, or medical educator who wants to:

• Understand exposure pathways

• Learn how toxicants may trigger glomerular disease

• Collaborate on patient education

• Explore emerging data

• Assist in case review

👉 We welcome you to reach out to us at EnlistedKidneyFoundation@gmail.com

The conversations happening now will shape how kidney disease is understood for generations.

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The Enlisted Kidney Foundation is committed to providing medically accurate, research-backed information. All sources above link directly to peer-reviewed journals and globally recognized clinical guidelines to support transparency and scientific integrity.