Heat Stress Nephropathy and Cardiovascular Surgery-Associated Renal Failure: Similarities and Implications

Heat Stress Nephropathy and Cardiovascular Surgery-Associated Renal Failure: Similarities and Implications

Puneet Dhawan, MD, Timothy L. Van Natta, MD, MS

Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA

Global Journal of Urology and Nephrology

Climate changes associated with global warming are producing challenges increasingly relevant to clinicians. Rising temperatures and extended heat waves are associated with a growing incidence of a recently described condition termed heat sensitivity nephropathy. Considering all causes of acute kidney injury and chronic kidney disease, those producing renal dysfunction consequent to cardiovascular surgery may most closely overlap those tied to kidney disease following excessive chronic or acute heat exposure.
In this review, heat sensitivity nephropathy and cardiovascular surgery related renal injury are characterized and compared. While both are global in distribution, the former has highest prevalence in remote, rural areas and difficult to study and quantify. Renal injury following cardiovascular surgery, occurring by contrast in relatively controlled settings, is more amenable to evaluation of diagnostic approaches, prognostic indicators, and potential treatments. Such findings may ultimately apply not only to surgically-related kidney damage but to heat sensitivity nephropathy as well.
Despite many studies addressing post-cardiovascular surgery renal failure, no single management method has emerged as definitively superior. Nonetheless, reasonably standardized worldwide conduct of cardiac and vascular surgery provides fertile conditions for research that could lead to improved diagnostic and therapeutic approaches. Such findings may ultimately apply to not only surgically-related renal injury but perhaps also to heat sensitivity nephropathy.
Instead of anticipating discovery of major isolated preventative or treatment methods applicable to either cause of renal failure, it is more realistic that a series of marginally successful measures employed in combination will engender the most nearterm progress. Potentially complimenting currently available options is biomarker analysis that may better guide both renal injury diagnosis and treatment efficacy assessment.

Keywords: heat sensitivity nephropathy; cardiovascular surgery-associated acute kidney injury; chronic kidney disease; end stage renal disease; biomarkers

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How to cite this article:
Puneet Dhawan, Timothy L. Van Natta. Heat Stress Nephropathy and Cardiovascular Surgery-Associated Renal Failure: Similarities and Implications. Global Journal of Urology and Nephrology, 2020, 3:22. DOI: 10.28933/gjun-2020-03-2505


1. Fox, M. Climate change: What does it mean for the future of surgery? Bulletin of the American College of Surgeons, September 1, 2019. http://bulletin.facs.org/2019/09/climate-change-what-does-it-mean-for-the-future-of-surgery/
2. Pezzella AT. Global cardiothoracic surgery advances and challenges in developing countries and emerging economies. CTSNet. 2018; doi:10.25373/ctsnet.7247249
3. Glaser J, Lemery J, Rajagopalan B, et al. Climate change and the emergent epidemic of CKD from heat stress in rural communities: the case for heat stress nephropathy. Clin J Am Soc Nephrol. 2016; 11(8):1472-83
4. Guirguis K, Gershunov A, Tardy A, Basu R. The impact of recent heat waves on human health in California. J Appl Meteorol Clim. 2014; 53(1):3-19
5. Horton SB. They leave their kidneys in the fields: illness, injury, and illegality among U.S. farm-workers. Oakland, CA: University of California Press, 2016
6. Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002; 346(25):1978-88
7. Garcίa-Arroyo FE, Cristobal M, Arellano-Buendia AD et al. Rehydration with soft drink-like beverages exacerbates dehydration and worsens dehydration-associated renal injury. Am J Physiol Regul Integr Comp Physiol. 2016; 311(1):R57-65; doi:10.1152/ajpregu.00354.2015.
8. Roncal Jimenez CA, Ishimoto T, Lanaspa MA, et al. Fructokinase activity mediates dehydration-induced renal injury. Kidney Int. 2014; 86:294-302
9. Levey A, James MT. Acute kidney injury. Ann Intern Med. 2017; 167(9):ITC65-80
10. Ostermann M, Joannidis M. Acute kidney injury 2016: diagnosis and diagnostic workup. Crit Care. 2016; 20(1):299
11. Bishal G, Ramakrishna K, Dhamoon AS. Sepsis: the evolution in definition, pathophysiology, and management. SAGE Open Medicine. 2019; 7:1-13, doi.org/10.1177/2050312119835043
12. O’Neal JB, Shaw AD, Billings FT. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care. 2016; 20(1):187, pii:e008834 doi:0.1186/s13054-016-1352-z
13. Nadim MK, Forni LG, Bihorac A, et al. Cardiac and vascular surgery-associated acute kidney injury: the 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group. J Am Heart Assoc. 2018; 7(11) doi:10.1161/JAHA.118008834
14. Rosner MH. Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol. 2006; 1(1):19-32
15. Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. Lancet. 2017; 389:941-50
16. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120:c179-84

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