Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA.
Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN 47405, USA.
Nutrients. 2019 Sep 4;11(9):2087. doi: 10.3390/nu11092087.
An epidemic of chronic kidney disease (CKD) is occurring in laborers who undertake physical work in hot conditions. Rodent data indicate that heat exposure causes kidney injury, and when this injury is regularly repeated it can elicit CKD. Studies in humans demonstrate that a single bout of exercise in the heat increases biomarkers of acute kidney injury (AKI). Elevations in AKI biomarkers in this context likely reflect an increased susceptibility of the kidneys to AKI. Data largely derived from animal models indicate that the mechanism(s) by which exercise in the heat may increase the risk of AKI is multifactorial. For instance, heat-related reductions in renal blood flow may provoke heterogenous intrarenal blood flow. This can promote localized ischemia, hypoxemia and ATP depletion in renal tubular cells, which could be exacerbated by increased sodium reabsorption. Heightened fructokinase pathway activity likely exacerbates ATP depletion occurring secondary to intrarenal fructose production and hyperuricemia. Collectively, these responses can promote inflammation and oxidative stress, thereby increasing the risk of AKI. Equivalent mechanistic evidence in humans is lacking. Such an understanding could inform the development of countermeasures to safeguard the renal health of laborers who regularly engage in physical work in hot environments.
在从事高温体力劳动的劳动者中，慢性肾脏病（CKD）的流行正在发生。啮齿动物数据表明，热暴露会导致肾脏损伤，而当这种损伤经常反复发生时，就会引发 CKD。人类研究表明，在高温下进行单次运动就会增加急性肾损伤（AKI）的生物标志物。在这种情况下，AKI 生物标志物的升高可能反映了肾脏对 AKI 的易感性增加。主要来自动物模型的数据表明，运动导致热相关 AKI 风险增加的机制是多因素的。例如，与热相关的肾血流量减少可能会引起肾内血流不均一。这会促进局部缺血、缺氧和肾小管细胞中 ATP 耗竭，而钠重吸收的增加可能会加剧这种情况。果糖激酶途径活性的增加可能会加剧由于肾内果糖产生和高尿酸血症引起的继发性 ATP 耗竭。这些反应共同促进炎症和氧化应激，从而增加 AKI 的风险。在人类中缺乏类似的机制证据。这种理解可以为制定对策提供信息，以保护经常在高温环境下从事体力劳动的劳动者的肾脏健康。
