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2017 ; 32
(4
): 598-602
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Pro: Heat stress as a potential etiology of Mesoamerican and Sri Lankan
nephropathy: a late night consult with Sherlock Holmes
#MMPMID28407135
Johnson RJ
Nephrol Dial Transplant
2017[Apr]; 32
(4
): 598-602
PMID28407135
show ga
Epidemics of chronic kidney disease are now recognized in Central America,
Mexico, India and Sri Lanka, and there is also some evidence that similar
epidemics may be occurring in the USA, Thailand and elsewhere. A common
denominator for each location is manually working outside in extremely hot
environments. Here we review the evidence that the primary etiology may be heat
stress related to repeated subclinical or clinical acute kidney injury that
eventually manifests as chronic kidney disease. In some aspects, the disease may
manifest as subclinical heat stroke, subclinical rhabdomyolysis or a subclinical
tumor lysis syndrome. While toxins could be involved, it would be difficult to
attribute this as a main mechanism, given the wide range of occupations and
geographic regions manifesting this disease. While some of the epidemics may be
due to better reporting, we believe the most important reasons are increasing
heat extremes (heat waves) coupled with hydration with sugary or, less commonly,
alcoholic beverages.