Chapman Christopher L, Johnson Blair D, Parker Mark D, Hostler David, Pryor Riana R, Schlader Zachary
Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, USA.
Department of Human Physiology, University of Oregon, Eugene, OR, USA.
Temperature (Austin). 2020 Oct 13;8(2):108-159. doi: 10.1080/23328940.2020.1826841. eCollection 2021.
The kidneys' integrative responses to heat stress aid thermoregulation, cardiovascular control, and water and electrolyte regulation. Recent evidence suggests the kidneys are at increased risk of pathological events during heat stress, namely acute kidney injury (AKI), and that this risk is compounded by dehydration and exercise. This heat stress related AKI is believed to contribute to the epidemic of chronic kidney disease (CKD) occurring in occupational settings. It is estimated that AKI and CKD affect upwards of 45 million individuals in the global workforce. Water and electrolyte disturbances and AKI, both of which are representative of kidney-related pathology, are the two leading causes of hospitalizations during heat waves in older adults. Structural and physiological alterations in aging kidneys likely contribute to this increased risk. With this background, this comprehensive narrative review will provide the first aggregation of research into the integrative physiological response of the kidneys to heat stress. While the focus of this review is on the human kidneys, we will utilize both human and animal data to describe these responses to passive and exercise heat stress, and how they are altered with heat acclimation. Additionally, we will discuss recent studies that indicate an increased risk of AKI due to exercise in the heat. Lastly, we will introduce the emerging public health crisis of older adults during extreme heat events and how the aging kidneys may be more susceptible to injury during heat stress.
肾脏对热应激的综合反应有助于体温调节、心血管控制以及水和电解质调节。最近的证据表明，在热应激期间，肾脏发生病理事件的风险增加，即急性肾损伤（AKI），而且脱水和运动使这种风险更加复杂。这种与热应激相关的急性肾损伤被认为是导致职业环境中慢性肾脏病（CKD）流行的原因之一。据估计，急性肾损伤和慢性肾脏病影响着全球劳动力中超过4500万人。水和电解质紊乱以及急性肾损伤，这两者都是肾脏相关病理的代表，是老年人在热浪期间住院的两个主要原因。衰老肾脏的结构和生理改变可能导致这种风险增加。在此背景下，这篇全面的叙述性综述将首次汇总关于肾脏对热应激的综合生理反应的研究。虽然本综述的重点是人类肾脏，但我们将利用人类和动物数据来描述对被动热应激和运动热应激的这些反应，以及它们如何因热适应而改变。此外，我们将讨论最近的研究，这些研究表明在炎热环境中运动导致急性肾损伤的风险增加。最后，我们将介绍极端高温事件期间老年人出现的新的公共卫生危机，以及衰老的肾脏在热应激期间如何更容易受到损伤。
