Kidney Function in Rice Workers Exposed to Heat and Dehydration in Costa Rica

Heat and health of occupational workers: a short summary of literature

Globally, occupational workers suffer various health impacts due to extreme heat. In this short review, we examine the literature discussing health impacts of heat on occupational workers, and then discuss certain individual and institutional measures needed to address the problem. Though the available literature in the recent decade discusses health impacts of heat on workers as various heat-related illnesses, we found very few studies examining how occupational workers suffer from issues concerning cardiovascular health, neurological health, respiratory health, and mental health. In this regard, we highlight the need for more studies to examine how occupational workers exposed to extreme heat conditions suffer from fatal health issues like cardiovascular attack, brain stroke, and other ailments impacting vital organs of the body. Occupational workers across the world should be made aware of measures to protect themselves from extreme heat. Further, countries should develop occupational heat safety guidelines with statutory effect.

Chronic kidney disease with unknown cause across the global spectrum

PURPOSE OF REVIEW

In the 1990s, a type of chronic kidney disease with unknown cause (CKDu) was identified in Central America and Sri Lanka. Patients lacked hypertension, diabetes, glomerulonephritis, or other usual causes of kidney failure. Affected patients are predominantly male agricultural workers aged 20-60 years, living in economically disadvantaged areas with poor access to medical care. Patients typically present late and progress to end-stage kidney disease within 5 years, resulting in social and economic hardship for families, regions, and countries. This review covers the current state of knowledge for this disease.

RECENT FINDINGS

The prevalence of CKDu is increasing in known endemic regions and across the globe, reaching epidemic proportions. There is primary tubulointerstitial injury with secondary glomerular and vascular sclerosis. No definitive etiologic factors have been identified, and these may vary or overlap in different geographic locations. The leading hypotheses include exposure to agrochemicals, heavy metals and trace elements, and kidney injury from dehydration/heat stress. Infections and lifestyle factors may play a role, but are likely not key. Genetic and epigenetic factors are beginning to be explored.

SUMMARY

CKDu is a leading cause of premature death in young-to-middle-aged adults in endemic regions and has become a public health crisis. Studies are underway to investigate clinical, exposome, and omics factors, and hopefully will provide insights into pathogenetic mechanisms resulting in biomarker discovery, preventive measures, and therapeutics.

Where do you live and what do you do? Two questions that might impact your kidney health

In many cases the social determinants of health need to be assessed through their interaction with environmental factors. This review looks at the impact of physical location and occupation of individuals on their kidney health. It examines the effect of living at high altitude on kidney function and the relationship between extreme cold or hot temperatures and the incidence of kidney injury. It reviews as well the many occupations that have been linked to kidney disease in high-income and low-and-middle-income countries. As a conclusion, this overview proposes preventive recommendations that could be individualized based on weather, altitude, socio-economic level of the country and occupation of the individual.