Early biomarkers for kidney injury in heat-related illness patients: a prospective observational study at Japanese Self-Defense Force Fuji Hospital

Abstract

Background Since heatstroke-induced acute kidney injury (AKI) can progress to chronic kidney disease, it would be useful to detect heatstroke-induced AKI and severe heat-related illness in the early phase. We studied the epidemiology of heat-related illness among patients in the Japanese Ground Self-Defense Force and evaluated the relationship between heat-related illness severity and early urinary biomarkers for AKI. Methods We enrolled patients who were diagnosed with heat-related illness at Self-Defense Force Fuji Hospital from May 1 to September 30, 2020. We compared the urinary kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), liver fatty acid binding protein (L-FABP), N-acetyl-β-D-glucosaminidase (NAG), and β2-microglobulin levels according to the severity of heat-related illness as defined by positive scores of the Japanese Association of Acute Medicine Heatstroke Working Group (JAAM-HS-WG) criteria (0, mild; 1, moderate; ≥2 (2+), severe). Results Of the 44 patients, kidney injury, defined as serum creatinine (sCr) ≥1.2 mg/dL, was seen in 9 (20.5%) patients. Urinary NAG, NGAL and L-FABP levels were significantly higher in the 2 + JAAM-HS-WG criteria group than in the 0 group. Furthermore, urinary L-FABP levels were positively correlated with sCr levels. In contrast, the urinary KIM-1 levels showed the best correlation with serum cystatin C (sCysC) among these biomarkers. Conclusions We conclude even mild to moderate heatstroke could lead to AKI. Urinary L-FABP is useful for detecting heatstroke-induced AKI and patients with severe heat-related illness requiring immediate treatment. Urinary KIM-1 may detect heatstroke-induced AKI in terms of sCysC, although it was not related to heat-related illness severity.

The feasibility of point-of-care testing for initial uninary liver fatty acid-binding protein to estimate pathophysiological severity in severe heatstroke

“…L-FABP has been approved for diagnostic testing of acute kidney injury in Japan 17 and can be measured within minutes using either a commercial-based assay kit or a POCT kit, with high accuracy. The POCT L-FABP kit requires only a small urine sample and can be performed outside hospital settings, such as in eld triage at athletic events or at home, without the need for blood samples.…”

Risk Factor Analysis and Nomogram for Predicting In-Hospital Mortality in ICU Patients with Heat Stroke: A National Multicenter Study

“…progress to renal failure necessitating dialysis. 34,[36][37][38] Elevated body temperature associated with heat stroke leads to inevitable kidney damage, characterized by tubular cell death. 39 Studies on sepsis have suggested that AKI independently contributes to increased patient mortality by causing electrolyte and acid-base disturbances, fluid retention, metabolic dysfunction, impaired neutrophil function, and compromised infection clearance.…”

Nefrología y seguridad y salud ocupacional: el maridaje obligado del cambio climático

“…), por citar algunos, pero aparentemente ninguno de ellos desarrolla enfermedad renal crónica (ERC) y mucho menos el cuadro clínico típico de nefropatía endémica de Mesoamérica. Por tanto, aunque nuestra comprensión de los efectos crónicos del calor en los riñones y en esta nefropatía regional es todavía limitada, no cabe duda de que puede producir LRA en estos pacientes [5][6][7] .…”