Heat Stress Nephropathy and Cardiovascular Surgery-Associated Renal Failure: Similarities and Implications

Abstract

Climate changes associated with global warming are producing challenges increasingly relevant to clinicians. Rising temperatures and extended heat waves are associated with a growing incidence of a recently described condition termed heat sensitivity nephropathy. Considering all causes of acute kidney injury and chronic kidney disease, those producing renal dysfunction consequent to cardiovascular surgery may most closely overlap those tied to kidney disease following excessive chronic or acute heat exposure. In this review, heat sensitivity nephropathy and cardiovascular surgery related renal injury are characterized and compared. While both are global in distribution, the former has highest prevalence in remote, rural areas and difficult to study and quantify. Renal injury following cardiovascular surgery, occurring by contrast in relatively controlled settings, is more amenable to evaluation of diagnostic approaches, prognostic indicators, and potential treatments. Such findings may ultimately apply not only to surgically-related kidney damage but to heat sensitivity nephropathy as well. Despite many studies addressing post-cardiovascular surgery renal failure, no single management method has emerged as definitively superior. Nonetheless, reasonably standardized worldwide conduct of cardiac and vascular surgery provides fertile conditions for research that could lead to improved diagnostic and therapeutic approaches. Such findings may ultimately apply to not only surgically-related renal injury but perhaps also to heat sensitivity nephropathy. Instead of anticipating discovery of major isolated preventative or treatment methods applicable to either cause of renal failure, it is more realistic that a series of marginally successful measures employed in combination will engender the most nearterm progress. Potentially complimenting currently available options is biomarker analysis that may better guide both renal injury diagnosis and treatment efficacy assessment.