Professor and Head, Department of General Medicine, Deben Mahata Government Medical College & Hospital, Purulia, West Bengal, India.
J Assoc Physicians India. 2024 Oct;72(10):110. doi: 10.59556/japi.72.0686.
Climate change has led to global warming since the last century, which has adverse health consequences. Heat stress nephropathy (HSN) is such a disorder that is emerging as an epidemic because of heat exposure, dehydration, and shortage of drinking water. HSN has been suspected to occur in different parts of the world. Many cases of chronic kidney disease of unknown etiology (CKDu) such as Mesoamerican nephropathy and Sri Lankan nephropathy are now being considered as HSN. Influences of agrochemicals (e.g., pesticides), heavy metals (e.g., cadmium, lead, arsenic, and fluoride), and genetic polymorphism were suspected for causation of CKDu in those cases, but results were inconsistent in different studies from different locations. Drinking water with high silica and strontium was also found in a region with high CKDu in South India. Malnutrition and infections such as leptospirosis can also cause CKDu. It is not clear whether CKDu in different hot locations studied represents a single disease or a group of different disorders, but the common factors found are heat and related dehydration. However, combined effects may also be possible. Dehydration from heat stress increases toxin exposure of different organs because of higher blood and urine concentration, as chronically dehydrated patients may not excrete toxic substances effectively. Also, the wells and water reservoirs are more concentrated with toxic substances because of hot weather due to evaporation.
自上个世纪以来，气候变化导致了全球变暖，这对人类健康产生了不良影响。热应激肾病（HSN）就是这样一种由于暴露于高温、脱水和饮用水短缺而出现的疾病。由于暴露于高温、脱水和饮用水短缺，HSN 已经在世界不同地区被怀疑发生。许多病因不明的慢性肾脏病（CKDu）病例，如中美洲肾病和斯里兰卡肾病，现在被认为是 HSN。人们怀疑农业化学品（如杀虫剂）、重金属（如镉、铅、砷和氟化物）和遗传多态性是导致这些病例中 CKDu 的原因，但不同地点的不同研究结果并不一致。在印度南部一个 CKDu 高发地区，也发现了高硅和锶的饮用水。营养不良和钩端螺旋体病等感染也会导致 CKDu。目前尚不清楚在不同炎热地区研究的 CKDu 是否代表一种单一疾病或一组不同的疾病，但发现的共同因素是热和相关的脱水。然而，也可能存在联合作用。热应激引起的脱水会增加不同器官的毒素暴露，因为血液和尿液浓度升高，而长期脱水的患者可能无法有效地排出毒素。此外，由于天气炎热导致蒸发，水井和水库中的有毒物质浓度更高。
