Thrombocytopenia as a predictor of severe acute kidney injury in patients with heat stroke

Unaccustomed strenuous physical exertion in hot environments can result in heat stroke and acute kidney injury (AKI). Both exercise-induced muscle damage and AKI are associated with the release of interleukin-6, but whether muscle damage causes AKI in the heat is unknown. We hypothesized that muscle-damaging exercise, before exercise in the heat, would increase kidney stress. Ten healthy euhydrated men underwent a randomized, crossover trial involving both a 60-min downhill muscle-damaging run (exercise-induced muscle damage; EIMD), and an exercise intensity-matched non-muscle-damaging flat run (CON), in random order separated by 2 wk. Both treatments were followed by heat stress elicited by a 40-min run at 33°C. Urine and blood were sampled at baseline, after treatment, and after subjects ran in the heat. By design, EIMD induced higher plasma creatine kinase and interleukin-6 than CON. EIMD elevated kidney injury biomarkers (e.g., urinary neutrophil gelatinase-associated lipocalin (NGAL) after a run in the heat: EIMD-CON, mean difference [95% CI]: 12 [5, 19] ng/ml) and reduced kidney function (e.g., plasma creatinine after a run in the heat: EIMD-CON, mean difference [95% CI]: 0.2 [0.1, 0.3] mg/dl), where CI is the confidence interval. Plasma interleukin-6 was positively correlated with plasma NGAL ( r = 0.9, P = 0.001). Moreover, following EIMD, 5 of 10 participants met AKIN criteria for AKI. Thus for the first time we demonstrate that muscle-damaging exercise before running in the heat results in a greater inflammatory state and kidney stress compared with non-muscle-damaging exercise. Muscle damage should therefore be considered a risk factor for AKI when performing exercise in hot environments.

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Impact of Acute Kidney Injury on Outcomes of Hospitalizations for Heat Stroke in the United States

Diseases ◽

10.3390/diseases8030028 ◽

2020 ◽

Vol 8 (3) ◽

pp. 28

Author(s):

Charat Thongprayoon ◽

Fawad Qureshi ◽

Tananchai Petnak ◽

Wisit Cheungpasitporn ◽

Api Chewcharat ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Resource Utilization ◽

Hospital Admissions ◽

Heat Stroke ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

The United States

This study aims to evaluate the risk factors and the association of acute kidney injury with treatments, complications, outcomes, and resource utilization in patients hospitalized for heat stroke in the United States. Hospitalized patients from years 2003 to 2014 with a primary diagnosis of heat stroke were identified in the National Inpatient Sample dataset. End stage kidney disease patients were excluded. The occurrence of acute kidney injury during hospitalization was identified using the hospital diagnosis code. The associations between acute kidney injury and clinical characteristics, in-hospital treatments, outcomes, and resource utilization were assessed using multivariable analyses. A total of 3346 hospital admissions were included in the analysis. Acute kidney injury occurred in 1206 (36%) admissions, of which 49 (1.5%) required dialysis. The risk factors for acute kidney injury included age 20–39 years, African American race, obesity, chronic kidney disease, congestive heart failure, and rhabdomyolysis, whereas age <20 or ≥60 years were associated with lower risk of acute kidney injury. The need for mechanical ventilation and blood transfusion was higher when acute kidney injury occurred. Acute kidney injury was associated with electrolyte and acid-base derangements, sepsis, acute myocardial infarction, ventricular arrhythmia or cardiac arrest, respiratory, circulatory, liver, neurological, hematological failure, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher in acute kidney injury patients. Approximately one third of heat stroke patients developed acute kidney injury during hospitalization. Acute kidney injury was associated with several complications, and higher mortality and resource utilization.

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Clinical Characteristics and Risk Factors Associated With Acute Kidney Injury Inpatient With Exertional Heatstroke: An Over 10-Year Intensive Care Survey

Frontiers in Medicine ◽

10.3389/fmed.2021.678434 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ming Wu ◽

Conglin Wang ◽

Zheying Liu ◽

Li Zhong ◽

Baojun Yu ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Intensive Care ◽

Clinical Characteristics ◽

Heat Stroke ◽

Treatment Strategies ◽

Kidney Injury ◽

Organ Injury ◽

Hospitalization Costs ◽

Gcs Score

Background: Exertional heat stroke (EHS) is a life-threatening injury that can lead to acute kidney injury (AKI). The clinical characteristics of and risk factors for EHS complicated with AKI have been poorly documented.Methods: A retrospective study with EHS admitted to the intensive care unit (ICU) from January 2008 to June 2019 was performed. Data including baseline clinical information at admission, main organ dysfunction, 90-day mortality and total cost of hospitalization were collected.Results: A total of 187 patients were finally included, of which 82 (43.9%) had AKI. AKI patients had more severe organ injury and higher total hospitalization costs than non-AKI patients. Multivariate logistic analysis showed that lymphocyte, neutrophil, D-dimer and myoglobin (MB) ≥ 1,000 ng/ml were independent risk factors for AKI caused by EHS. In addition, SOFA score [hazard ratio (HR) 4.1, 95% confidence interval (95% CI) 1.6–10.8, P = 0.004] and GCS score (HR 3.2, 95% CI 1.2–8.4 P = 0.017) were the risk factor for 90-day mortality in patients with EHS complicated with AKI, with an area under the curve (AUC) of 0.920 (95% CI 0.842–0.998, P < 0.001) and 0.851 (95% CI 0.739–0.962, P < 0.001), respectively. Survival analysis showed that the 90-day mortality in AKI patients was significantly high (P < 0.0001) and the mortality rate of patients with AKI stage 2 was the highest than other stages.Conclusions: EHS complicated with AKI is associated with higher hospitalization costs and poorly clinical outcomes. MB ≥1,000 ng/ml, Inflammation, coagulation were associated with the occurrence and development of AKI. Early treatment strategies based reducing the SOFA and GCS score may be pivotal for improving the prognosis of EHS.

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Rasburicase improves hyperuricemia in patients with acute kidney injury secondary to rhabdomyolysis caused by ecstasy intoxication and exertional heat stroke

Pediatric Critical Care Medicine ◽

10.1097/pcc.0b013e3182192c8d ◽

2011 ◽

Vol 12 (6) ◽

pp. e424-e427 ◽

Cited By ~ 18

Author(s):

Pei-Yi Lin ◽

Chun-Chen Lin ◽

Hsi-Che Liu ◽

Ming-Dar Lee ◽

Hung-Chang Lee ◽

...

Keyword(s):

Acute Kidney Injury ◽

Heat Stroke ◽

Kidney Injury ◽

Exertional Heat Stroke ◽

Ecstasy Intoxication

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Rhabdomyolysis and Acute Kidney Injury due to Severe Heat Stroke

Case Reports in Critical Care ◽

10.1155/2011/951719 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Máximo H. Trujillo ◽

Carlos Fragachán G.

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Heat Stroke ◽

Ventilatory Support ◽

Kidney Injury ◽

Multiple Organ ◽

Strenuous Exercise ◽

Acute Seizures ◽

Healthy Female ◽

Icu Treatment

We present a case of heat stroke (HS) and acute kidney injury (AKI) due to severe rhabdomyolysis in a 14-year-old previously healthy female patient. When she was practicing strenuous exercise she suffered acute seizures and high fever. These symptoms were followed by coma and multiple organ failure (MOF), which included AKI, encephalopathy, fulminant hepatic failure (FHF), and disseminated intravascular coagulation (DIC). The patient was managed in the ICU with renal replacement therapy, ventilatory support, and other vital supporting measures. After three weeks of ICU treatment she made a full recovery.

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