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Sasai F, Roncal-Jimenez C, Rogers K, Sato Y, Brown JM, Glaser J, Garcia G, Sanchez-Lozada LG, Rodriguez-Iturbe B, Dawson JB, Sorensen C, Hernando AA, Gonzalez-Quiroz M, Lanaspa M, Newman LS, Johnson RJ. Climate change and nephrology. Nephrol Dial Transplant 2023; 38:41-48. [PMID: 34473287 PMCID: PMC9869860 DOI: 10.1093/ndt/gfab258] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 01/26/2023] Open
Abstract
Climate change should be of special concern for the nephrologist, as the kidney has a critical role in protecting the host from dehydration, but it is also a favorite target of heat stress and dehydration. Here we discuss how rising temperatures and extreme heat events may affect the kidney. The most severe presentation of heat stress is heat stroke, which can result in severe electrolyte disturbance and both acute and chronic kidney disease (CKD). However, lesser levels of heat stress also have multiple effects, including exacerbating kidney disease and precipitating cardiovascular events in subjects with established kidney disease. Heat stress can also increase the risk for kidney stones, cause multiple electrolyte abnormalities and induce both acute and chronic kidney disease. Recently there have been multiple epidemics of CKD of uncertain etiology in various regions of the world, including Mesoamerica, Sri Lanka, India and Thailand. There is increasing evidence that climate change and heat stress may play a contributory role in these conditions, although other causes, including toxins, could also be involved. As climate change worsens, the nephrologist should prepare for an increase in diseases associated with heat stress and dehydration.
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Affiliation(s)
- Fumihiko Sasai
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carlos Roncal-Jimenez
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Keegan Rogers
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Yuka Sato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jared M Brown
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Gabriela Garcia
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Bernardo Rodriguez-Iturbe
- Laboratory of Renal Physiopathology, Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City
- Instituto Nacional de Cencias Médicas y Nutrición "Salvador Zubirán", Department of Nephrology, Mexico City, Mexico
| | - Jaime Butler Dawson
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cecilia Sorensen
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ana Andres Hernando
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marvin Gonzalez-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
- Centre for Nephrology, University College London, London, UK
| | - Miguel Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lee S Newman
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Fisher JD, Shah AP, Norozian F. Clinical Spectrum of Pediatric Heat Illness and Heatstroke in a North American Desert Climate. Pediatr Emerg Care 2022; 38:e891-e893. [PMID: 33848093 DOI: 10.1097/pec.0000000000002438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The spectrum of historical features and clinical presentations of heat illness and heatstroke in the pediatric population has received limited focus in the emergency medicine literature. The majority of published cases involve children trapped in closed spaces and adolescent athletes undergoing high-intensity training regimens in geographical regions with moderately high ambient temperatures and high humidity. There has been less research on the potential impact of extreme temperatures and radiant heat that are the hallmarks of the US southwest region. We performed a retrospective review of pediatric heat illness at our facility located in a North American desert climate.
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Affiliation(s)
- Jay D Fisher
- From the Department of Emergency Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV
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Filep EM, Murata Y, Endres BD, Kim G, Stearns RL, Casa DJ. Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E589. [PMID: 33167534 PMCID: PMC7694459 DOI: 10.3390/medicina56110589] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/15/2020] [Accepted: 10/27/2020] [Indexed: 12/20/2022]
Abstract
Background and Objectives: The purpose of this systematic review is to synthesize the influence cooling modality has on survival with and without medical complications from exertional heat stroke (EHS) in sport and military populations. Methods and Materials: All peer-reviewed case reports or series involving EHS patients were searched in the following online databases: PubMed, Scopus, SPORTDiscus, Medline, CINAHL, Academic Search Premier, and the Cochrane Library: Central Registry of Clinical Trials. Cooling methods were subdivided into "adequate" (>0.15 °C/min) versus "insufficient" (<0.15 °C/min) based on previously published literature on EHS cooling rates. Results: 613 articles were assessed for quality and inclusion in the review. Thirty-two case reports representing 521 EHS patients met the inclusion criteria. Four hundred ninety-eight (498) patients survived EHS (95.58%) and 23 (4.41%) patients succumbed to complications. Fischer's Exact test on 2 × 2 contingency tables and relative risk ratios were calculated to determine if modality cooling rate was associated with patient outcomes. EHS patients that survived who were cooled with an insufficient cooling rate had a 4.57 times risk of medical complications compared to patients who were treated by adequate cooling methods, regardless of setting (RR = 4.57 (95%CI: 3.42, 6.28)). Conclusions: This is the largest EHS dataset yet compiled that analyzes the influence of cooling rate on patient outcomes. Zero patients died (0/521, 0.00%) when treatment included a modality with an adequate cooling rate. Conversely, 23 patients died (23/521, 4.41%) with insufficient cooling. One hundred seventeen patients (117/521, 22.46%) survived with medical complications when treatment involved an insufficient cooling rate, whereas, only four patients had complications (4/521, 0.77%) despite adequate cooling. Cooling rates >0.15 °C/min for EHS patients were significantly associated with surviving EHS without medical complications. In order to provide the best standard of care for EHS patients, an aggressive cooling rate >0.15 °C/min can maximize survival without medical complications after exercise-induced hyperthermia.
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Affiliation(s)
- Erica M. Filep
- Korey Stringer Institute, University of Connecticut, Storrs, CT 06269-1110, USA; (B.D.E.); (G.K.); (R.L.S.); (D.J.C.)
| | - Yuki Murata
- Graduate School of Education and Human Development, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan;
| | - Brad D. Endres
- Korey Stringer Institute, University of Connecticut, Storrs, CT 06269-1110, USA; (B.D.E.); (G.K.); (R.L.S.); (D.J.C.)
| | - Gyujin Kim
- Korey Stringer Institute, University of Connecticut, Storrs, CT 06269-1110, USA; (B.D.E.); (G.K.); (R.L.S.); (D.J.C.)
| | - Rebecca L. Stearns
- Korey Stringer Institute, University of Connecticut, Storrs, CT 06269-1110, USA; (B.D.E.); (G.K.); (R.L.S.); (D.J.C.)
| | - Douglas J. Casa
- Korey Stringer Institute, University of Connecticut, Storrs, CT 06269-1110, USA; (B.D.E.); (G.K.); (R.L.S.); (D.J.C.)
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A Case of Exertional Heat Stroke Complicated by Hypoxic Hepatitis. Case Rep Emerg Med 2020; 2020:8724285. [PMID: 32292608 PMCID: PMC7149357 DOI: 10.1155/2020/8724285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/10/2020] [Indexed: 11/28/2022] Open
Abstract
Background Exertional heat stroke is a life-threatening condition often complicated by multiorgan failure. We hereby present a case of a 25-year-old male presenting with syncope after a 10 km run in 28°C outside temperature who developed acute liver failure. Case Presentation. Initial temperature was found to be 41.1°C, and cooling measures were rapidly applied. He suffered from acute renal failure and rhabdomyolysis and proceeded to acute liver failure (ASAT 6100 U/l and ALAT 6561 U/l) due to hypoxic hepatitis on day 3. He did not meet criteria for emergency liver transplantation and recovered on supportive care. Conclusions Acute liver failure due to heat stroke is a life-threatening condition with often delayed onset, which nevertheless resolves on supportive care in the majority of cases; thus, a delayed referral to transplant seems to be reasonable.
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Diagnostic value of coagulation factor and intracranial pressure monitoring in acute liver failure from heat stroke: case report and review of the literature. Transplant Proc 2016; 47:817-9. [PMID: 25891738 DOI: 10.1016/j.transproceed.2015.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/10/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Exertional heat stroke (HS) with resultant acute liver failure (ALF) is a rare condition with high mortality. Diagnosis of ALF in the context of HS is confounded by numerous laboratory abnormalities related to multisystem organ dysfunction. CASE REPORT We present the case of a 20-year-old male athlete with exertional HS who developed ALF and was treated successfully with orthotopic liver transplantation. He remained well after 1 year with normal liver function and no permanent neurologic impairment. Diagnosis and treatment was guided by serial monitoring of coagulation factors and intracranial pressure (ICP). CONCLUSIONS Currently, there are no well validated prognostic tools that predict the need for or survival with orthotopic liver transplantation for HS. We propose that serial monitoring of coagulation factors and, when safe and feasible, ICP monitoring may help to guide clinical decision making in this context.
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