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Pathophysiological mechanisms by which heat stress potentially induces kidney inflammation and chronic kidney disease in sugarcane workers

Hansson, Erik LU ; Glaser, Jason ; Jakobsson, Kristina LU ; Weiss, Ilana ; Wesseling, Catarina ; Lucas, Rebekah A.I. ; Wei, Jason Lee Kai ; Ekström, Ulf LU ; Wijkström, Julia and Bodin, Theo LU , et al. (2020) In Nutrients 12(6).
Abstract

Background: Chronic kidney disease of non-traditional origin (CKDnt) is common among Mesoamerican sugarcane workers. Recurrent heat stress and dehydration is a leading hypothesis. Evidence indicate a key role of inflammation. Methods: Starting in sports and heat pathophysiology literature, we develop a theoretical framework of how strenuous work in heat could induce kidney inflammation. We describe the release of pro-inflammatory substances from a leaky gut and/or injured muscle, alone or in combination with tubular fructose and uric acid, aggravation by reduced renal blood flow and increased tubular metabolic demands. Then, we analyze longitudinal data from >800 sugarcane cutters followed across harvest and review the CKDnt... (More)

Background: Chronic kidney disease of non-traditional origin (CKDnt) is common among Mesoamerican sugarcane workers. Recurrent heat stress and dehydration is a leading hypothesis. Evidence indicate a key role of inflammation. Methods: Starting in sports and heat pathophysiology literature, we develop a theoretical framework of how strenuous work in heat could induce kidney inflammation. We describe the release of pro-inflammatory substances from a leaky gut and/or injured muscle, alone or in combination with tubular fructose and uric acid, aggravation by reduced renal blood flow and increased tubular metabolic demands. Then, we analyze longitudinal data from >800 sugarcane cutters followed across harvest and review the CKDnt literature to assess empirical support of the theoretical framework. Results: Inflammation (CRP elevation and fever) and hyperuricemia was tightly linked to kidney injury. Rehydrating with sugary liquids and NSAID intake increased the risk of kidney injury, whereas electrolyte solution consumption was protective. Hypokalemia and hypomagnesemia were associated with kidney injury. Discussion: Heat stress, muscle injury, reduced renal blood flow and fructose metabolism may induce kidney inflammation, the successful resolution of which may be impaired by daily repeating pro-inflammatory triggers. We outline further descriptive, experimental and intervention studies addressing the factors identified in this study.

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type
Contribution to journal
publication status
published
subject
keywords
Acute kidney injury, Heat, Heat stress, Hydration, Inflammation, Kidney, Occupation
in
Nutrients
volume
12
issue
6
article number
1639
publisher
MDPI AG
external identifiers
  • scopus:85085923011
  • pmid:32498242
ISSN
2072-6643
DOI
10.3390/nu12061639
language
English
LU publication?
yes
id
91366667-c605-4b1c-99c6-3d0e64e32524
date added to LUP
2020-07-29 12:48:49
date last changed
2020-11-16 01:39:13
@article{91366667-c605-4b1c-99c6-3d0e64e32524,
  abstract     = {<p>Background: Chronic kidney disease of non-traditional origin (CKDnt) is common among Mesoamerican sugarcane workers. Recurrent heat stress and dehydration is a leading hypothesis. Evidence indicate a key role of inflammation. Methods: Starting in sports and heat pathophysiology literature, we develop a theoretical framework of how strenuous work in heat could induce kidney inflammation. We describe the release of pro-inflammatory substances from a leaky gut and/or injured muscle, alone or in combination with tubular fructose and uric acid, aggravation by reduced renal blood flow and increased tubular metabolic demands. Then, we analyze longitudinal data from &gt;800 sugarcane cutters followed across harvest and review the CKDnt literature to assess empirical support of the theoretical framework. Results: Inflammation (CRP elevation and fever) and hyperuricemia was tightly linked to kidney injury. Rehydrating with sugary liquids and NSAID intake increased the risk of kidney injury, whereas electrolyte solution consumption was protective. Hypokalemia and hypomagnesemia were associated with kidney injury. Discussion: Heat stress, muscle injury, reduced renal blood flow and fructose metabolism may induce kidney inflammation, the successful resolution of which may be impaired by daily repeating pro-inflammatory triggers. We outline further descriptive, experimental and intervention studies addressing the factors identified in this study.</p>},
  author       = {Hansson, Erik and Glaser, Jason and Jakobsson, Kristina and Weiss, Ilana and Wesseling, Catarina and Lucas, Rebekah A.I. and Wei, Jason Lee Kai and Ekström, Ulf and Wijkström, Julia and Bodin, Theo and Johnson, Richard J. and Wegman, David H.},
  issn         = {2072-6643},
  language     = {eng},
  month        = {06},
  number       = {6},
  publisher    = {MDPI AG},
  series       = {Nutrients},
  title        = {Pathophysiological mechanisms by which heat stress potentially induces kidney inflammation and chronic kidney disease in sugarcane workers},
  url          = {http://dx.doi.org/10.3390/nu12061639},
  doi          = {10.3390/nu12061639},
  volume       = {12},
  year         = {2020},
}