Blog entry by Meguid El Nahas

Anyone in the world

Clin J Am Soc Nephrol. 2016 Aug 8;11(8):1472-83. doi: 10.2215/CJN.13841215. Epub 2016 May 5.

Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy.

Abstract

Climate change has led to significant rise of 0.8°C-0.9°C in global mean temperature over the last century and has been linked with significant increases in the frequency and severity of heat waves (extreme heat events). Climate change has also been increasingly connected to detrimental human health. One of the consequences of climate-related extreme heat exposure is dehydration and volume loss, leading to acute mortality from exacerbations of pre-existing chronic disease, as well as from outright heat exhaustion and heat stroke. Recent studies have also shown that recurrent heat exposure with physical exertion and inadequate hydration can lead to CKD that is distinct from that caused by diabetes, hypertension, or GN. Epidemics of CKD consistent with heat stress nephropathy are now occurring across the world. Here, we describe this disease, discuss the locations where it appears to be manifesting, link it with increasing temperatures, and discuss ongoing attempts to prevent the disease. Heat stress nephropathy may represent one of the first epidemics due to global warming. Government, industry, and health policy makers in the impacted regions should place greater emphasis on occupational and community interventions.

 Comments

This review published in the August issue of cJASN argues for a Heat Stress Nephropathy (HSN) associated with Global warming...

It would involve a variety of incidences of renal impairment in countries such as El Salvador/Central America (Mesoamerican nephropathy, Sugar cane Nephropathy), Sri Lanka and India.

The review implicates global warming, dehydration, nephrotoxins as well as heavy metal contamination of drinking water, not to mention the ever present hyperuricemia and also hypokalemia as well as fructose toxicity...

The reality is that agriculture workers working unprotected for very long long hours in extreme heat are simply prone to dehydration...

Longterm dehydration leads to longterm activation of the renin angiotensin aldosterone system (RAAS) that leads to renal ischemia and chronic hypokalemia; severe dehydration along with chronic hypokalemia (observed in many of these workers) is enough to cause impaired renal function in anybody...

So rather than calling these conditions fancy names, it suffices that we acknowledge that dehydration is not good for the kidneys...and that adequate hydration is essential for workers of any type in any country working under extreme heat conditions!

Nephrologists love to come up with new "Nephropathies", it gives them a claim to have "discovered" and labelled an entity, even when it is as mundane as dehydration...!

Some recent examples of labelling...

Warfarin nephropathy: Basically raised serum creatinine in sick and multi-comorbidities, over anticoagulated, patients with CVD...causal link with warfarin unproven!

Smoking Nephropathy: Basically CKD in heavy smokers...with multiple comorbidities and underlying CVD...causal link with heavy smoking unproven!

Mesoamerican nephropathy: Dehydration in agricultural workers...link with anything else unproven!

Sugar Cane nephropathy: Dehydration in agricultural workers...(not just sugar cane), affecting those working a low altitude and extreme heat and not the cooler higher altitude farmers...

Fructose nephropathy, Uric Acid Nephropathy, etc...

In the case of "Heat Stess Nephropathy"...it would better be called Dehydration induce kidney failure...its prevention in adequate hydration and better working conditions of those exposed to hot climate...it treatment is re-hydration before long term damage takes place!

Lets keep the simple, simple and make its prevention and management equally simple.

As to Climate Change and Global Warming...thats better left to geographers and politicians...as we, as nephrologists, have no data to compare the incidence of impaired kidney function...before and after global warming...!?

Fianlly, another CKD "Epidemic"... another term to make the problem sound more important, urgent, and global...Dehydration on the other hand, would not have the same linguistic impact, but would be much nearer the truth...as the evidence of a HSN induced epidemic is as shaky as that of the CKD "epidemic" that has been branded around the last 20 years...

[ Modified: Thursday, 1 January 1970, 1:00 AM ]