Introduction
Nephropathy is a broad medical term to describe kidney disease or damage that can lead to kidney failure. The kidney’s primary function is to eliminate waste products and regulate the body’s water and acid-base balance. Therefore, loss of renal function is a potentially fatal condition. Heat stress is defined as the total heat load an individual is exposed to depending on environmental conditions and work intensity with respect to time, clothing, and acclimatization.
What Is Heat Stress Nephropathy?
High temperatures cause serious kidney problems. Dehydration leads to low blood pressure, decreased kidney function, and breakdown of muscle tissue leading to kidney failure. Heart failure and shock during an episode of severe heat stroke can also lead to renal failure.
What Are the Causes of Heat Stress Nephropathy?
The causes of heat stress nephropathy are as follows:
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Doing exercise and strenuous activity in high temperatures.
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Having a low water intake.
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Prolonged exposure to nephrotoxic drugs (medication having damaging kidney effect) and staying in a warm climate.
Who Is at Risk of Heat Stress Nephropathy?
There is a high risk of developing heat stress nephropathy in the following group of people:
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It most commonly occurs in people who work for long hours under the sun, such as construction workers and people working in fields and farms.
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People stay in regions of high heat levels, like deserts and near the equator.
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Athletes, especially those competing in endurance sports such as marathons, triathlons, and cycling tournaments.
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People with chronic diseases such as diabetes, kidney disease, cystic fibrosis, alcoholism, and adrenal disease.
What Are the Symptoms of Heat Stress Nephropathy?
The various symptoms of heat stress nephropathy are as follows:
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Reduced Urine Output: Heat stress nephropathy causes the kidney to produce less urine.
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A High Body Temperature: The body’s core temperature of 104 degrees Fahrenheit (40 degrees Celsius) or higher, measured by a thermometer, is the primary sign of heat stress.
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Changes in Mental State or Behavior: Confusion, agitation, slurred speech, nervousness, delirium, seizures, and coma can all be caused by heat stress.
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Change in Sweat Production Rate: Heat stress in warm weather results in hot and dry skin. However, heat stress caused by strenuous exercise can dry out the skin and make it a little sticky.
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Nausea and Vomiting: Heat stress may be accompanied by nausea and vomiting.
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Flushed Skin: Due to the temperature rise, the skin may turn red.
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Breathing Fast: Breathing may become rapid and shallow in heat stress.
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Increased Heart Rate: Heat stress puts a lot of strain on the heart to cool down the body, which can cause the heart rate to rise significantly.
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Headache: The head may start pounding with a severe headache.
What Are the Possible Complications of Heat Stress Nephropathy?
Repeated heat stress episodes may cause the following complications:
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A person may develop an acute kidney injury, chronic kidney disease, or renal failure.
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Due to reduced urine output, there may be increased susceptibility to urinary tract infections.
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Chronic kidney disease may lead to the accumulation of toxins in the body which may warrant regular dialysis.
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There is a risk of further damage to organs like the liver, lungs, and heart, whose functioning is directly dependent on the kidneys.
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Chronic high blood pressure.
When to Get Help for Heat Stress Nephropathy?
If a person is warm, confused, or delirious, is not urinating frequently, and is breathing rapidly, should be taken to a cooler environment. Emergency services should be contacted, and the individual should be transported to an emergency facility.
How Is Heat Stress Nephropathy Diagnosed?
Routine screening tests may include the following:
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Albumin Test in Urine: This test can detect blood protein albumin in the urine. Normally, the kidneys do not filter albumin from the blood. Too much protein in the urine can indicate poor functioning of the kidneys.
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Albumin/Creatinine Ratio: Creatinine is the chemical waste compound that healthy kidneys filter out of the blood. The albumin/creatinine ratio – is the measure of the albumin present in a urine sample relative to the amount of creatinine. It also acts as an indicator of renal function.
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Glomerular Filtration Rate (GFR): By measuring creatinine in a blood sample, the physician can estimate how quickly the kidneys filter the blood (glomerular filtration rate). A low filtration rate indicates poor renal function.
Other diagnostic tests include:
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Imaging Test: The doctor may use X-rays and ultrasound to assess the structure and size of the kidneys. CT scans (computed tomography scan) and MRI (magnetic resonance imaging) can also be used to determine the state of blood circulation within the kidneys. In some cases, other image processing techniques can also be used.
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Renal Biopsy: The doctor may recommend a kidney biopsy to obtain a sample of kidney tissue after administering local anesthesia. Doctors then use a fine needle to remove a tiny piece of kidney tissue for examination under a microscope.
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Muscle Function Test: This test is carried out to analyze the extent of muscle damage (rhabdomyolysis).
How Is Heat Stress Nephropathy Treated?
Heat stress is treated by replenishing the fluid levels by:
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Consuming clear liquids such as water, clear broth, frozen water or popsicles, or sports drinks.
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Patients require intravenous fluids for hydration.
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Dehydrated people should avoid caffeinated drinks such as tea, coffee, and soda.
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Working for long hours in heat should be stopped.
For advanced stages of heat stress nephropathy, the following treatment modalities are considered:
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Dialysis: This treatment removes waste products and excess water from the blood. There are two main types of dialysis: Peritoneal dialysis and hemodialysis. The first, more common method requires visits to a dialysis center about three times a week to be hooked up to an artificial kidney machine or undergo dialysis at home by a trained nurse. Each session lasts 3 to 5 hours. Hemodialysis, the second method, can also be done at home.
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Transplant: In some cases, a kidney or kidney-pancreas transplant is the best option. Tests determine if a person is a suitable candidate for transplant surgery.
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Symptom Management: All the symptoms are managed according to the person’s current health parameters.
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Treatment of Underlying Conditions: Conditions that cause dehydration should also be identified and treated with appropriate medications. These may include medicines available over the counter.
How to Prevent Heat Stress Nephropathy?
The following special precautions should be taken to prevent heat stress nephropathy:
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Avoid leaving children and elderly in closed cars or rooms with high temperatures for long periods.
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Avoid taking diuretics and alcohol as it prevents the cooling down of the body.
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Drink plenty of water (room temperature only) and apply ice on the face and forehead to keep the body cool and hydrated.
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In the absence of an air conditioner, install an air fan and keep the windows open to maintain circulation.
Conclusion:
It is important to avoid dehydration and strenuous activities in heat because people are at an elevated risk of kidney injury and heat stress nephropathy over time. In addition, a lack of water and electrolyte imbalance in the body may cause various kidney problems. Therefore, people working long hours in the heat and athletes should regularly seek kidney checkups to prevent long-term damage.
