Role of heat shock proteins in renal function and adaptation to heat stress: Implications for global warming

Table 1 Effect of heat stress on renal function in high-risk populations: Clinical, investigation, manifestations, and prognostic implications

High-risk populations	Systemic clinical manifestations	Organ-specific clinical manifestations	Investigation	Prognosis	Ref.
Outdoor workers	Fever, dizziness, dehydration, fatigue, and hypotension	Flank pain, reduced urine output, and peripheral edema (renal and cardiovascular systems)	Elevated creatinine and BUN levels, decreased eGFR, and proteinuria	High risk of AKI and CKD, and recurrent hospitalizations	Chapman et al[163], Gallo-Ruiz et al[170]
Agricultural laborers	Fatigue, intense thirst, and heat exhaustion	Flank pain and oliguria (renal system)	Electrolyte disturbances, elevated creatinine levels, and proteinuria	High risk of nondiabetic CKD; repeated AKI episodes due to chronic dehydration	Wesseling et al[178], Nerbass et al[179]
Kitchen workers (chefs)	Dehydration, fatigue, and dizziness	Oliguria and lower limb edema (renal system)	Reduced eGFR and proteinuria	2.8-fold increased risk of AKI compared with the general population	Koh[171]
Brick manufacturing workers	Heat exhaustion, fatigue, and muscle pain	Flank pain and oliguria (renal system)	Elevated BUN and creatinine levels and reduced eGFR	High probability of latent CKD due to prolonged heat exposure	Gallo-Ruiz et al[170]
Marathon runners	Dehydration, muscle cramps, and heat exhaustion	Flank discomfort and urgency of urination (renal system)	Electrolyte imbalance and elevated creatinine levels	Transient AKI; reversible with prompt management	Tidmas et al[172]
Elderly individuals (aged ≥ 65 years)	Impaired thirst sensation, dizziness, and altered mental status	Hypertension, cardiac insufficiency, and oliguria (cardiovascular and renal systems)	Reduced creatinine clearance, elevated N-terminal pro B-type natriuretic peptide levels, and electrolyte imbalance	Rapid CKD progression; higher risk of hospitalization and mortality	Glaser et al[173], Johnson et al[174], Tran et al[175]
Pregnant women	Fatigue, hypotension, and dizziness	Proteinuria, pedal edema, and gestational hypertension (renal and cardiovascular systems)	Decreased eGFR, elevated liver enzyme levels, and proteinuria	Increased risk of preeclampsia, intrauterine growth restriction, and pregnancy-related AKI	Moronge et al[176]
Immunocompromised individuals	Persistent fever, fatigue, and increased infection susceptibility	Recurrent urinary tract infections and hematuria (renal system)	Elevated C-reactive protein levels, leukopenia, and increased creatinine levels	High risk of renal deterioration; susceptibility to multiorgan failure	Leon et al[177]

AKI: Acute kidney injury; BUN: Blood urea nitrogen; CKD: Chronic kidney disease; eGFR: Estimated glomerular filtration rate.