Nephron · 2026
CKDu and Heat Stress Nephropathy Across Eras: Regional Heterogeneity, Occupational Evidence, and Prevention in a Warming World.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Corrêa Lucas Maciel de Almeida, Brandão Luiggi Kevin Virgino, Mazur Gabriel Rian, Santiago Clara Belo Gamon, Barbosa Alexandre de Assis, Dutra Júnior Ivan Felipe, de Santana Gabriel Costa, Delmiro Silva Yan Roberth, Dante Letícia Esteves
Аннотация
BACKGROUND: Chronic kidney disease of uncertain etiology (CKDu), increasingly framed as heat stress nephropathy (HSN) in endemic settings, has evolved from a regional enigma into a climate-health concern. Affecting young workers outside the diabetes-hypertension axis, it shows how heat, labor, dehydration, and social vulnerability converge on the kidney. CKDu/HSN is best approached as heterogeneous kidney disease phenotypes: occupational heat stress is strongly supported in Mesoamerica and selected populations, whereas co-exposures, water insecurity, vulnerability, and genetic or developmental susceptibility may modify risk elsewhere.
SUMMARY: This review traces CKDu/HSN from agricultural communities to its relevance as a nephrology and public-health priority. We discuss the shift from unstable definitions and geographic labels toward a clinicopathologic and policy framework. Available data support a layered model in which recurrent heat exposure, dehydration, workload, subclinical acute kidney injury, tubular stress, endogenous fructogenesis, oxidative injury, and co-exposures may contribute with different weights across settings. However, human causal validation remains incomplete, and CKDu should not be treated as a single etiologic diagnosis. We synthesize biomarker and histopathologic evidence supporting a tubulointerstitial phenotype and examine how climate change is expanding heat-related kidney risk.
KEY MESSAGES: CKDu/HSN has preventable and measurable components at the intersection of climate, work, and kidney health. The strongest interventional evidence comes from occupational programs, water-rest-shade or rest-shade-hydration-hygiene strategies in sugarcane workers, including the Adelante Initiative, which improved kidney-related outcomes without clear loss of operational viability. Nephrology must translate this evidence into prevention, early detection, resilient kidney care, and climate-conscious planning.
SUMMARY: This review traces CKDu/HSN from agricultural communities to its relevance as a nephrology and public-health priority. We discuss the shift from unstable definitions and geographic labels toward a clinicopathologic and policy framework. Available data support a layered model in which recurrent heat exposure, dehydration, workload, subclinical acute kidney injury, tubular stress, endogenous fructogenesis, oxidative injury, and co-exposures may contribute with different weights across settings. However, human causal validation remains incomplete, and CKDu should not be treated as a single etiologic diagnosis. We synthesize biomarker and histopathologic evidence supporting a tubulointerstitial phenotype and examine how climate change is expanding heat-related kidney risk.
KEY MESSAGES: CKDu/HSN has preventable and measurable components at the intersection of climate, work, and kidney health. The strongest interventional evidence comes from occupational programs, water-rest-shade or rest-shade-hydration-hygiene strategies in sugarcane workers, including the Adelante Initiative, which improved kidney-related outcomes without clear loss of operational viability. Nephrology must translate this evidence into prevention, early detection, resilient kidney care, and climate-conscious planning.