Heat Stress Nephropathy From Exercise-Induced Uric Acid Crystalluria: A Perspective on Mesoamerican Nephropathy

Roncal-Jiménez, Carlos A.; Gárcía-Trabanino, Ramón; Barregård, Lars; Lanaspa, Miguel A.; Wesseling, Catharina; Harra, Tamara; Aragón, Aurora; Gráses, F.; Jarquín, Emmanuel; González, Marvin; Weiss, Ilana; Glaser, Jason; Sánchez‐Lozada, Laura G.; Johnson, Richard J.

doi:10.1053/j.ajkd.2015.08.021

Cited by 154 publications

(122 citation statements)

References 100 publications

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“…Rhabdomyolysis is a well known cause of AKI (62), and repeated exposures may lead to CKD. Finally, hyperuricemia and uricosuria associated with heat stress may lead to excessive levels of uric acid in the urine, which may also crystallize in the urine, and this has also been documented in the affected sugarcane workers (28). Indeed, many subjects complain of intermittent dysuria from the passage of sand-like material (termed chistata in Nicaragua and mal de orín in El Salvador) due to urate crystalluria, and this is frequent in sugarcane workers and is associated with signs of dehydration (50,63,64).…”

Section: Hsn: the Cause Of Mesoamerican Nephropathy?mentioning

confidence: 98%

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

Glaser¹,

Lemery²,

Rajagopalan³

et al. 2016

CJASN

Self Cite

336

264

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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.

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Section: Hsn: the Cause Of Mesoamerican Nephropathy?mentioning

confidence: 98%

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

Glaser¹,

Lemery²,

Rajagopalan³

et al. 2016

CJASN

Self Cite

336

264

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“…It has also been shown that muscles under these conditions release myoglobin that can produce acute kidney damage, especially in combination with dehydration (17)(18)(19). In addition, systems regulating water and electrolyte balance become overwhelmed, resulting in urine acidification, concentration, and uricosuria (15,20). Eventually, with repeated subclinical kidney injury, CKD may evolve (21).…”

Section: Wegman Et Almentioning

confidence: 99%

Intervention to diminish dehydration and kidney damage among sugarcane workers

Wegman¹,

Apelqvist²,

Bottai³

et al. 2017

Scand J Work Environ Health

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Strenuous work in hot environments is associated with negative impacts on biomarkers of kidney function over the workday and over five months. Appropriate access to water, rest and shade during work offers relief from high levels of heat stress and reduces effects on kidney function.Affiliation: University of Massachusetts Lowell, 7 Camden Place, Cambridge, MA 02138, USA. david_wegman@uml.eduThe following article refers to this text: 2018;44(1):1-2

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“…87,88 Although the roles of toxins and infections have not been completely ruled out, common risk factors for each of the epidemics are hot temperatures and recurrent dehydration that can be linked with climate change. 89 Although acute dehydration is known to cause a transient reduction in kidney function without permanent renal damage, chronic recurrent heat-induced dehydration causes CKD in mice. 50 The mechanism for CKD may involve hyperosmolarity-induced alteration of fructose and vasopressin metabolism ( Figure 2).…”

Section: Ckdmentioning

confidence: 99%

“…91 An increase in serum and urinary uric acid also occurs with heat and exercise, which increases the risk for urinary urate crystal formation. 89,92 The possibility that dehydration may be a risk factor for CKD should also be considered. Low urine output 93,94 and high urine osmolarity 95 predict risk for the progression of CKD.…”

Section: Ckdmentioning

confidence: 99%

Metabolic and Kidney Diseases in the Setting of Climate Change, Water Shortage, and Survival Factors

Johnson

Stenvinkel

Jensen

et al. 2016

JASN

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Climate change (global warming) is leading to an increase in heat extremes and coupled with increasing water shortage, provides a perfect storm for a new era of environmental crises and potentially, new diseases. We use a comparative physiologic approach to show that one of the primary mechanisms by which animals protect themselves against water shortage is to increase fat mass as a means for providing metabolic water. Strong evidence suggests that certain hormones (vasopressin), foods (fructose), and metabolic products (uric acid) function as survival signals to help reduce water loss and store fat (which also provides a source of metabolic water). These mechanisms are intricately linked with each other and stimulated by dehydration and hyperosmolarity. Although these mechanisms were protective in the setting of low sugar and low salt intake in our past, today, the combination of diets high in fructose and salty foods, increasing temperatures, and decreasing available water places these survival signals in overdrive and may be accelerating the obesity and diabetes epidemics. The recent discovery of multiple epidemics of CKD occurring in agricultural workers in hot and humid environments may represent harbingers of the detrimental consequences of the combination of climate change and overactivation of survival pathways.

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Heat Stress Nephropathy From Exercise-Induced Uric Acid Crystalluria: A Perspective on Mesoamerican Nephropathy

Cited by 154 publications

References 100 publications

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

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

Intervention to diminish dehydration and kidney damage among sugarcane workers

Metabolic and Kidney Diseases in the Setting of Climate Change, Water Shortage, and Survival Factors

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