{"id":68837,"date":"2022-12-22T11:46:26","date_gmt":"2022-12-22T13:46:26","guid":{"rendered":"https:\/\/www.pasveik.lt\/?p=68837\/sveikatos-ir-medicinos-naujienos"},"modified":"2022-12-22T11:46:27","modified_gmt":"2022-12-22T13:46:27","slug":"klimato-kaita-ir-inkstai","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/klimato-kaita-ir-inkstai\/68837\/","title":{"rendered":"Klimato kaita ir inkstai<\/strong>"},"content":{"rendered":"\n

\u017dem\u0117s temperat\u016bros kilimui pastaruoju metu skiriama labai daug d\u0117mesio. Nustatyta, kad per pastaruosius 50 met\u0173 m\u016bs\u0173 planetos pavir\u0161iaus temperat\u016bra pakilo apie 0,8\u00a0\u00b0C. Atrodyt\u0173, toks pakilimas n\u0117ra labai reik\u0161mingas, bet to pakanka sukelti didelius \u017emogaus sveikatos pakitimus\u00a0[1]. Vienas ry\u0161kiausi\u0173 padarini\u0173 b\u016bt\u0173 ekstremali\u0173 \u0161ilumini\u0173 \u012fvyki\u0173, vadinam\u0173 kar\u0161\u010dio bangomis, pagaus\u0117jimas [2\u20134]. Kar\u0161\u010dio bangos \u2013 da\u017eniausia vis\u0173 su orais susijusi\u0173 \u012fvyki\u0173 mirties prie\u017eastis Jungtin\u0117se Amerikos Valstijose (\u012fskaitant tornadus, uraganus ir \u017eaibo sm\u016bgius) [5]. Pasaulyje kar\u0161\u010dio bangos 1980\u20132017 metais pateko \u012f pirm\u0105j\u012f da\u017eniausi\u0173 mirties prie\u017eas\u010di\u0173 d\u0117l stichini\u0173 nelaimi\u0173 de\u0161imtuk\u0105. Nors apibr\u0117\u017eimai ir skiriasi, ta\u010diau da\u017eniausiai kar\u0161\u010dio bangomis vadinama temperat\u016bra, kuri yra vidutini\u0161kai 5\u00a0\u00b0C didesn\u0117 negu vidutin\u0117 auk\u0161\u010diausia temperat\u016bra, nustatyta t\u0105 dien\u0105, ir tokia i\u0161liekanti ma\u017eiausiai 5 dienas\u00a0[6]. Dauguma tyrim\u0173 atskleid\u0117 did\u0117jant\u012f kar\u0161\u010dio bang\u0173\u00a0da\u017en\u012f visame pasaulyje [7]. Pavyzd\u017eiui, remiantis vienais skai\u010diavimais, d\u0117l klimato kaitos vien 2015 metais buvo 175\u00a0mln. daugiau \u017emoni\u0173, paveikt\u0173 kar\u0161\u010dio bang\u0173 [7]. Kar\u0161\u010dio bangos \u017emogui pavojingos ne tik d\u0117l perkaitimo rizikos, bet ir d\u0117l padid\u0117jusio asmen\u0173, sergan\u010di\u0173 \u0161irdies ir kraujagysli\u0173, kv\u0117pavimo sistemos sutrikimais, mirtingumo\u00a0[6]. Viena sunkiausi\u0173 Europos kar\u0161\u010dio bang\u0173 fiksuota 2003 met\u0173 rugpj\u016bt\u012f. Su ja siejamos 73\u00a0t\u016bkst. asmen\u0173 mir\u010di\u0173 [8]. Kar\u0161\u010dio bangos suk\u0117l\u0117 reik\u0161mingus mirtingumo protr\u016bkius visame pasaulyje, \u012fskaitant \u010cikag\u0105 (1995 metai) [9], Pakistan\u0105 (2015 metai) [12] ir Indij\u0105 (2014\u20132015 metai)\u00a0[10, 11]. Ekstremalus kar\u0161tis ir kar\u0161\u010dio bangos neigiamai veikia \u017emoni\u0173 darbingum\u0105, darbo efektyvum\u0105, pas\u0117li\u0173 augim\u0105 [14]. Manoma, kad ateityje pietin\u0117s pasaulio dalys taps tokios kar\u0161tos, kad nebebus galima jose gyventi [15, 17]. D\u0117l to termoreguliacija yra b\u016btina i\u0161gyvenimui. Palaikyti gerai hidratuot\u0105 b\u016bkl\u0119 privaloma, ta\u010diau i\u0161kyla problem\u0173, nes tinkamo vartoti vandens atsarg\u0173 pasaulyje ma\u017e\u0117ja. Mokslininkai prognozuoja, kad ateityje apie 10\u00a0proc. pasaulio populiacijos gali tr\u016bkti geriamojo vandens [18, 19]. Manoma, kad dalis \u017emoni\u0173, net ir tur\u0117dami prieig\u0105 prie vandens \u0161altinio, n\u0117ra gerai hidratuoti\u00a0[20].<\/p>\n\n\n\n

\u0160iame straipsnyje ap\u017evelgiami klimato kaitos padariniai inkst\u0173 ligomis sergantiems pacientams. Inkstai atlieka svarbi\u0105 funkcij\u0105 i\u0161saugojant kraujo t\u016br\u012f, palaiko normal\u0173 arterin\u012f kraujo spaudim\u0105, ekstral\u0105stelin\u012f ir intral\u0105stelin\u012f osmoliali\u0161kum\u0105. Viena svarbiausi\u0173 inkst\u0173 funkcij\u0173 yra \u0161lapimo koncentravimas, kuris suma\u017eina skys\u010di\u0173 praradim\u0105, u\u017etikrindamas azoto turin\u010di\u0173 metabolit\u0173 pa\u0161alinim\u0105. Deja, d\u0117l didelio metabolinio darbo ir koncentruot\u0173 atliek\u0173 \u0161alinimo inkstai yra labai jautr\u016bs klimato kaitos sukeltoms ligoms. Tyrimais nustatyta, kad did\u0117janti aplinkos temperat\u016bra yra susijusi su didesniu \u012f skubiosios pagalbos skyrius besikreipian\u010di\u0173 \u017emoni\u0173, kuriems sutrikusi inkst\u0173 funkcija, skai\u010diumi [21, 22].<\/p>\n\n\n\n

Perkaitimas ir \u016bminiai inkst\u0173 sutrikimai<\/strong><\/p>\n\n\n\n

Ekstremalaus kar\u0161\u010dio padarinys yra perkaitimas. Taip atsitinka, kai \u017emogaus k\u016bnas negali tinkamai kontroliuoti temperat\u016bros, tod\u0117l i\u0161sivysto hipertermija (temperat\u016bra siekia 40,6 \u00b0C). Hipertermijai b\u016bdingi simptomai yra klied\u0117jimas, s\u0105mon\u0117s praradimas, traukuliai, daugybinis organ\u0173 sutrikimas [5]. Perkaitim\u0105 gali sukelti kar\u0161\u010dio bangos, labai intensyvus sportas ar fizinis darbas \u0161iltoje aplinkoje [24]. Fizinis perkaitimas da\u017eniausiai nustatomas kariams, maratono b\u0117gikams, kasykl\u0173 darbininkams ar \u016bkininkams [25\u201329]. \u0160i problema da\u017enesn\u0117 nutukusiems, senyvo am\u017eiaus asmenims ar sergantiesiems cukriniu diabetu, \u0161irdies ir kraujagysli\u0173 sistemos ligomis.<\/p>\n\n\n\n

Perkaitimo simptomai gali skirtis sunkumu. Sunkiems simptomams priskiriami s\u0105mon\u0117s sutrikimas, klied\u0117jimas, \u016bminis kepen\u0173 ar inkst\u0173 funkcijos sutrikimas.<\/p>\n\n\n\n

Yra i\u0161skiriamos 2 \u016bminio inkst\u0173 funkcijos sutrikimo formos, pasirei\u0161kian\u010dios d\u0117l perkaitimo [24]. Viena forma pasirei\u0161kia labai padid\u0117jusia kreatinino fosfokinaz\u0117s koncentracija (>1 000 \u00b5\/l) (klasikin\u0117 rabdomioliz\u0117) ir yra susijusi su hiperurikemija ir dehidratacijos po\u017eymiais. \u0160i forma da\u017enesn\u0117 \u012fvykus fiziniam perkaitimui. Kitai formai b\u016bdinga normali ar saikiai padid\u0117jusi kreatinino fosfokinaz\u0117s koncentracija. \u0160i forma  da\u017eniau nustatoma esant epideminiams perkaitimams [24], jai b\u016bdingesnis \u016bminis inkst\u0173 kanal\u0117li\u0173 pa\u017eeidimas su urinarine leukocitoze ir hematurija. Inkst\u0173 biopsijos rodmenys atskleid\u017eia \u016bmin\u012f tubulointersticin\u012f nefrit\u0105. Manoma, kad \u0161ios formos \u016bmin\u012f inkst\u0173 funkcijos sutrikim\u0105 lemia i\u0161emija, didel\u0117s temperat\u016bros sukeltas oksidacinis stresas ir suma\u017e\u0117j\u0119s intral\u0105stelinis energijos kaupimas [30, 31].<\/p>\n\n\n\n

Perkaitimas da\u017enai yra susij\u0119s ir su elektrolit\u0173 disbalansu [24, 32]. Viename tyrime, kuriame dalyvavo 66 tiriamieji, patyr\u0119 fizin\u012f perkaitim\u0105, 91 proc. i\u0161 j\u0173 buvo diagnozuota \u016bmin\u0117 inkst\u0173 liga, 53 proc. \u2013 hiponatremija, 71 proc. \u2013 hipokalemija, 59 proc. \u2013 hipofosfatemija, 51 proc. \u2013 hipokalcemija, 35 proc. \u2013 hipomagnezemija [32]. Labai ma\u017ea kalio, fosforo, magnio koncentracija kraujo serume buvo susijusi su padid\u0117jusiu \u0161i\u0173 elektrolit\u0173 i\u0161skyrimu su \u0161lapimu d\u0117l inkst\u0173 kanal\u0117li\u0173 defekto bei prakaitavimu. Daliai \u0161i\u0173 pacient\u0173 buvo diagnozuota respiracin\u0117 alkaloz\u0117, suma\u017einanti serumo fosfat\u0173 kiek\u012f, ta\u010diau metabolin\u0117 acidoz\u0117 buvo da\u017enesn\u0117.<\/p>\n\n\n\n

Nustatyta, kad apie 10\u201330 proc. asmen\u0173, kuriems d\u0117l perkaitimo i\u0161sivysto \u016bminis inkst\u0173 funkcijos sutrikimas, prireikia dializ\u0117s [32]. Pasitaiko atvej\u0173, kai d\u0117l perkaitimo per kelis m\u0117nesius i\u0161sivysto l\u0117tin\u0117 inkst\u0173 liga ir l\u0117tinis tubulointersticinis nefritas, nustatomas atliekant biopsij\u0105 [33, 34].<\/p>\n\n\n\n

Per didel\u0117s \u0161ilumos sukelta nefropatija \u2013 l\u0117tin\u0117s inkst\u0173 ligos prie\u017eastis<\/strong><\/p>\n\n\n\n

Pastaraisiais metais \u012fvairiuose \u0161ilt\u0173j\u0173 kra\u0161t\u0173 regionuose buvo nustatyta daug l\u0117tin\u0117s inkst\u0173 ligos atvej\u0173. Da\u017eniausiai \u0161i liga buvo diagnozuojama asmenims, dirbantiems lauke \u0161vie\u010diant kar\u0161tai saulei [35]. Daugiausiai d\u0117l aplinkos kar\u0161\u010dio pasirei\u0161kusi\u0173 l\u0117tin\u0117s inkst\u0173 ligos atvej\u0173 buvo nustatyta palei centrin\u0117s Amerikos Ramiojo vandenyno pakrant\u0119, kur gausu besivystan\u010di\u0173 \u0161ali\u0173, paplitusi \u017eem\u0117s \u016bkio kult\u016bra [36]. \u012erodym\u0173 apie didel\u0117s aplinkos temperat\u016bros ir l\u0117tin\u0117s inkst\u0173 ligos ry\u0161\u012f yra nuo 1970 met\u0173 [38, 39]. Tai leido i\u0161kelti hipotez\u0119, kad liga gali b\u016bti susijusi su globaliniu at\u0161ilimu [40].<\/p>\n\n\n\n

Pateikiama daugiau \u012frodym\u0173, kad LIL gali sukelti pasikartojantys \u016bminiai inkst\u0173 funkcijos sutrikimai d\u0117l klinikinio ar subklinikinio perkaitimo [42]. Pastaruoju metu prane\u0161ta apie pakartotinius \u016bminius inkst\u0173 funkcijos sutrikimus cukranendri\u0173 laukuose dirbantiems asmenims b\u016btent centrin\u0117s Amerikos regione [43\u201346]. Nors daugelis atvej\u0173 yra besimptomiai, kartais pasitaiko kar\u0161\u010diavimas, leukocitoz\u0117, leukociturija, kai kuriais atvejais pacientams prireikia ir stacionarinio gydymo [47\u201349]. Pastarieji atvejai primena perkaitim\u0105, nes turi pana\u0161ias elektrolit\u0173 anomalijas, o biopsijos m\u0117ginyje stebimas \u016bminis intersticinis nefritas [47\u201349].<\/p>\n\n\n\n

Eksperimentiniai tyrimai pagrind\u017eia \u0161i\u0105 s\u0105saj\u0105. Pasikartojantis \u0161ilumos stresas ir dehidratacija gali sukelti l\u0117tin\u012f u\u017edegim\u0105 ir kanal\u0117li\u0173 sutrikim\u0105 pel\u0117ms ir \u017eiurk\u0117ms [50\u201352]. Tai tikriausiai yra susij\u0119 su padid\u0117jusia vidine k\u016bno temperat\u016bra, hiperosmoliali\u0161kumu, vazopresino funkcijos sutrikimais, kanal\u0117li\u0173 ir glomerul\u0173 funkcijos sutrikimais [50\u201352]. Klinikiniai tyrimai rodo, kad kar\u0161tis ir dehidratacija skatina \u0161lapimo koncentracijos did\u0117jim\u0105, jo pH ma\u017e\u0117jim\u0105 ir gali didinti uratini\u0173 kristal\u0173 susiformavim\u0105 bei kanal\u0117li\u0173 pa\u017eeidim\u0105 [53].<\/p>\n\n\n\n

\u016amin\u0117s inkst\u0173 ligos yra paplitusios viso pasaulio \u0161iltuosiuose regionuose \u2013 Indijoje (Adhra Pare\u0161as), \u0160ri Lankoje (centrin\u0117 \u0161iaur\u0117s provincija), Meksikoje (Verakrusas), centrin\u0117je Floridoje ir centrin\u0117je Kalifornijoje [56\u201358]. \u0160iose \u0161alyse taip pat diagnozuojama nema\u017eai l\u0117tin\u0117s inkst\u0173 ligos atvej\u0173 [59\u201361]. Didel\u012f r\u016bpest\u012f kelia tai, kad \u0161ios epidemijos gali b\u016bti susijusios su did\u0117jan\u010dia pasaulio temperat\u016bra ir \u0161ilumos bang\u0173 skai\u010diumi.<\/p>\n\n\n\n

Kiti \u0161iluminio streso padariniai inkstams: akmenys ir infekcijos<\/strong><\/p>\n\n\n\n

Pastaraisiais metais daugiau nustatoma inkst\u0173 akmenlig\u0117s atvej\u0173 [62]. Manoma, kad tai lemia su klimato kaita susij\u0119s aplinkos temperat\u016bros did\u0117jimas [63]. \u0160iluminis stresas ir dehidratacija skatina \u0161lapimo koncentracijos did\u0117jim\u0105 ir \u0161lapimo t\u016brio ma\u017e\u0117jim\u0105. Tai sudaro palankias s\u0105lygas akmenims formuotis [64]. Manoma, kad jei klimatas ir toliau \u0161ils, Jungtin\u0117se Amerikos Valstijose su aplinkos temperat\u016bra siejam\u0173 inkst\u0173 akmenlig\u0117s atvej\u0173 padaug\u0117s ne tik pietiniuose, bet ir \u0161iauriniuose regionuose [63]. Eksperimentiniai tyrimai rodo, kad d\u0117l didel\u0117s aplinkos temperat\u016bros poveikio daugiau gaminama \u0161lapimo r\u016bg\u0161ties, kuri, koncentruojantis \u0161lapimui, i\u0161krinta kristalais [64].<\/p>\n\n\n\n

\u0160ilt\u0117jantis klimatas ir d\u0117l to suma\u017e\u0117jusi hidratacija didina \u0161lapimo tak\u0173 infekcijos rizik\u0105. Naujausi tyrimai rodo, kad, padidinus kasdien suvartojamo vandens kiek\u012f, padid\u0117ja \u0161lapimo t\u016bris ir suma\u017e\u0117ja \u0161lapimo tak\u0173 infekcijos rizika [65].<\/p>\n\n\n\n

Gaivieji g\u0117rimai ir kar\u0161\u010dio sukelti inkst\u0173 pa\u017eeidimai<\/strong><\/p>\n\n\n\n

Gaivi\u0173j\u0173 g\u0117rim\u0173 sud\u0117tyje yra fruktoz\u0117s \u2013 cukraus, kuris, metabolizuojamas inkstuose, gali sukelti \u0161io organo vietin\u012f kanal\u0117li\u0173 funkcijos sutrikim\u0105, u\u017edegim\u0105 [66]. Naujausi\u0173 tyrim\u0173 duomenimis, gausiai vartojami gaivieji g\u0117rimai gali padidinti \u016bminio ir l\u0117tinio inkst\u0173 funkcijos sutrikimo i\u0161sivystymo rizik\u0105 [67]. Eksperimentiniuose tyrimuose su grau\u017eikais nustatyta, kad dehidratavusioms \u017eiurk\u0117ms rehidratacijai skiriant gaivi\u0173j\u0173 g\u0117rim\u0173, reik\u0161mingai padid\u0117ja inkst\u0173 funkcijos sutrikim\u0173 i\u0161sivystymo da\u017enis [51, 68]. Nustatyta, kad fruktoz\u0117 didina vazopresino i\u0161skyrim\u0105. Tai irgi didina inkst\u0173 pa\u017eaidos rizik\u0105 [51, 69]. Klinikiniuose tyrimuose pasteb\u0117ta, kad sveikiems asmenims po mank\u0161tinimosi, pakilus didesnei aplinkos temperat\u016brai, gaivieji g\u0117rimai gali sukelti inkst\u0173 pa\u017eeidim\u0105 (padid\u0117ja inkst\u0173 pa\u017eeidimo \u017eymenys [70], nors epidemiologiniai tyrimai iki \u0161i\u0173 dien\u0173 nerado joki\u0173 asociacij\u0173.<\/p>\n\n\n\n

Papildomas toksini\u0173 med\u017eiag\u0173 poveikis<\/strong><\/p>\n\n\n\n

Remiantis \u0161iuo metu turimais duomenimis, manoma, kad \u0161iluma d\u0117l dehidratacijos gali skatinti nat\u016brali\u0173 ir sintetini\u0173 toksini\u0173 med\u017eiag\u0173 koncentracijos did\u0117jim\u0105 inkstuose. Tai turi \u012ftaik\u0105 inkst\u0173 pa\u017eaidai. Med\u017eiagos, kuri\u0173 koncentracija tokiais atvejais gali did\u0117ti, yra sunkieji metalai, nefrotoksiniai \u017eem\u0117s \u016bkio chemikalai, tabakas, naudojami vaistai nuo u\u017edegimo. \u0160ioje srityje atliekama ir daugiau detalesni\u0173 tyrim\u0173.<\/p>\n\n\n\n

Apibendrinimas<\/strong><\/p>\n\n\n\n

Inkstai atlieka svarb\u0173 vaidmen\u012f saugodami organizm\u0105 nuo perkaitimo, ta\u010diau jie patys n\u0117ra atspar\u016bs \u017ealingam didel\u0117s temperat\u016bros poveikiui. Perkaitimas ir dehidratacija gali sukelti tiek \u016bmin\u012f, tiek l\u0117tin\u012f inkst\u0173 funkcijos sutrikim\u0105, elektrolit\u0173 disbalans\u0105, padidinti inkst\u0173 akmenlig\u0117s ir \u0161lapimo tak\u0173 u\u017edegimini\u0173\u00a0\/\u00a0infekcini\u0173 lig\u0173 rizik\u0105. T\u0119siantis visuotiniam at\u0161ilimui, b\u016btina d\u0117ti visas pastangas, siekiant u\u017etikrinti tinkam\u0105 hidratacij\u0105 ir vengti perkaitimo. Tai labai aktualu pa\u010diose pa\u017eeid\u017eiamiausiose visuomen\u0117s grup\u0117se, kurioms gresia perkaitimas. Turi b\u016bti atnaujinamos rekomendacijos ir per\u017ei\u016brimos \u012fsp\u0117jamosios kar\u0161\u010dio sistemos darboviet\u0117se, skatinamos visuomen\u0117s sveikatos \u0161vietimo iniciatyvos [71, 72]. Svarbiausia, moksliniais tyrimais tur\u0117t\u0173 b\u016bti siekiama i\u0161siai\u0161kinti, kaip sul\u0117tinti, sustabdyti globalin\u012f at\u0161ilim\u0105.<\/p>\n\n\n\n

<\/p>\n\n\n\n

Parengta pagal Johnson, Richard J, et al. Climate Change and the Kidney. Annals of Nutrition and Metabolism, vol. 74, no. Suppl 3, 2019, p. 38+. Gale Academic OneFile, Accessed 19 Nov. 2020.<\/em><\/p>\n\n\n\n

Egl\u0117 Stani\u0161auskyt\u0117<\/strong>
Lietuvos sveikatos moksl\u0173 universiteto Medicinos fakultetas<\/p>\n\n\n\n

<\/p>\n\n\n\n

LITERAT\u016aRA<\/strong><\/p>\n\n\n\n

1. Global Climate Change and Human Health. San Francisco: Jossey-Bass; 2015.
2. Fischer EM, Knutti R. Anthropogenic contribution to global occurrence of heavy precipitation and high temperature extremes. Nat Clim Chang. 2015; 5(6): 560\u20134.
3. Meehl GA, Tebaldi C. More intense, more frequent, and longer lasting heat waves in the 21st century. Science. 2004 Aug; 305(5686): 994\u20137.
4. Rahmstorf S, Coumou D. Increase of extreme events in a warming world. Proc Natl Acad Sci USA. 2011 Nov; 108(44): 17905\u20139.
5. Luber G, McGeehin M. Climate change and extreme heat events. Am J Prev Med. 2008 Nov; 35(5): 429\u201335.
6. The Lancet. Heatwaves and health. Lancet. 2018 Aug; 392(10145): 359.
7. Watts N, et al. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet. 2018 Feb; 391(10120): 581\u2013630.
8. Robine JM, et al. Death toll exceeded 70,000 in Europe during the summer of 2003. C R Biol. 2008 Feb; 331(2): 171\u2013 8.
9. Dematte JE, et al. Near-fatal heat stroke during the 1995 heat wave in Chicago. Ann Intern Med. 1998 Aug; 129(3): 173\u2013 81.
10. Mahant S. The evaluation and management of heat injuries in an intensive care unit. Indian J Crit Care Med. 2015 Aug; 19(8): 479\u2013 83.
11. Anonymous. India Heat Wave Kills More Than 1,400; Temperatures Soar To 118 Degrees, Associated Press, 2015. Available from: https:\/\/weather.com\/news\/news\/india-heatwave-latest-news<\/a>.
12. Dearden L. Karachi heat wave: Death toll tops 1,000 as government and electricity company trade blame: The Independent, 2015. Available from: http:\/\/www.independent.co.uk\/news\/world\/asia\/pakistan-heatwave-death-toll-tops-1000-as-governmentand-electricity-company-tradeblame-10344719.html<\/a>.
13. Dally M, et al. The impact of heat and impaired kidney function on productivity of Guatemalan sugarcane workers. PLoS One. 2018 Oct; 13(10):e0205181.
14. Friel S. Climate change, food insecurity and chronic diseases: sustainable and healthy policy opportunities for Australia. N S W Public Health Bull. 2010 May-Jun; 21(5\u20136): 129\u201333.
15. Kang S, Eltahir EA. North China Plain threatened by deadly heatwaves due to climate change and irrigation. Nat Commun. 2018 Jul; 9(1): 2894.
16. Pal JS, Eltahir EA. Future temperature in southwest Asia projected to exceed a threshold for human adaptability. Nat Clim Chang. 2016; 6(2): 197\u2013200.
17. Im ES, Pal JS, Eltahir EA. Deadly heat waves projected in the densely populated agricultural regions of South Asia. Sci Adv. 2017 Aug; 3(8):e1603322.
18. V\u00f6r\u00f6smarty CJ, Green P, Salisbury J, Lammers RB. Global water resources: vulnerability from climate change and population growth. Science. 2000 Jul; 289(5477): 284\u20138.
19. Kummu M, Ward PJ, de Moel H, Varis O. Is physical water scarcity a new phenomenon? Global assessment of water shortage over the last two millennia. Environ Res Lett. 2010; 5: 034006.
20. Morin C, et al. Fluid intake patterns of children and adolescents: results of six Liq.In7 national cross-sectional surveys. Eur J Nutr. 2018 Jun; 57(Suppl 3): 113\u2013 23.
21. Borg M, Bi P, Nitschke M, Williams S, McDonald S. The impact of daily temperature on renal disease incidence: an ecological study. Environ Health. 2017 Oct; 16(1): 114.
22. Borg M, et al. Using the excess heat factor to indicate heatwave-related urinary disease: a case study in Adelaide, South Australia. Int J Biometeorol. 2019 Apr; 63(4): 435\u201347.
23. Tawatsupa B, Lim LL, Kjellstrom T, Seubsman SA, Sleigh A, Study Team TC; Thai Cohort Study Team. Association between occupational heat stress and kidney disease among 37,816 workers in the Thai Cohort Study (TCS). J Epidemiol. 2012; 22(3): 251\u201360.
24. Hart GR, et al. Epidemic classical heat stroke: clinical characteristics and course of 28 patients. Medicine (Baltimore). 1982 May; 61(3): 189\u201397.
25. Adams T, et al. Exertional heat stroke. Br J Hosp Med (Lond). 2012 Feb; 73(2): 72\u20138.
26. Bedno SA, et al. Exertional heat illness among overweight U.S. Army recruits in basic training. Aviat Space Environ Med. 2010 Feb; 81(2): 107\u201311. 27 Casa DJ, Armstrong LE, Ganio MS, Yeargin SW. Exertional heat stroke in competitive athletes. Curr Sports Med Rep. 2005 Dec; 4(6): 309\u201317.
27. Goforth CW, Kazman JB. Exertional heat stroke in navy and marine personnel: a hot topic. Crit Care Nurse. 2015 Feb; 35(1): 52\u20139.
28. Staal W\u00e4sterlund D. Managing heat in agricultural work: increasing worker safety and productivity by controlling heat exposure. Forestry Working Paper. Rome, Food and Agricultural Organization of the United Nations. 2018; 1: 1\u201367.
29. Zager RA, Altschuld R. Body temperature: an important determinant of severity of ischemic renal injury. Am J Physiol. 1986 Jul; 251(1 Pt 2):F87\u201393.
30. Zager RA. Hyperthermia: effects on renal ischemic\/reperfusion injury in the rat. Lab Invest. 1990 Sep; 63(3): 360\u20139.
31. Satirapoj B, Kongthaworn S, Choovichian P, Supasyndh O. Electrolyte disturbances and risk factors of acute kidney injury patients receiving dialysis in exertional heat stroke. BMC Nephrol. 2016 Jun; 17(1): 55.
32. Kew MC, Abrahams C, Levin NW, Seftel HC, Rubenstein AH, Bersohn I. The effects of heatstroke on the function and structure of the kidney. Q J Med. 1967 Jul; 36(143): 277\u2013 300.
33. Kew MC, Abrahams C, Seftel HC. Chronic interstitial nephritis as a consequence of heatstroke. Q J Med. 1970 Apr; 39(154): 189\u2013 99.
34. Johnson RJ, Wesseling C, Newman LS. Epidemic Chronic Kidney Disease in Agricultural Communities. N Engl J Med. Forthcoming 2019.
35. Correa-Rotter R, Wesseling C, Johnson RJ. CKD of unknown origin in Central America: the case for a Mesoamerican nephropathy. Am J Kidney Dis. 2014 Mar; 63(3): 506\u2013 20.
36. Wesseling C, et al. Mesoamerican nephropathy: geographical distribution and time trends of chronic kidney disease mortality between 1970 and 2012 in Costa Rica. Occup Environ Med. 2015 Oct; 72(10): 714\u201321.
37. Crowe J, Nilsson M, Kjellstrom T, Wesseling C. Heat-related symptoms in sugarcane harvesters. Am J Ind Med. 2015 May; 58(5): 541\u2013 8.
38. Crowe J, Wesseling C, Solano BR, Uma\u00f1a MP, Ram\u00edrez AR, Kjellstrom T, et al. Heat exposure in sugarcane harvesters in Costa Rica. Am J Ind Med. 2013 Oct; 56(10): 1157\u2013 64.
39. Glaser J,et al. Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy. Clin J Am Soc Nephrol. 2016 Aug; 11(8): 1472\u201383.
40. Diaz HF, et al. Increasing Heat Stress, Kidney Disease, and Possible Connection to Climate Change in Selected Regions of Central America. Clim Change. Forthcoming 2019.
41. Johnson RJ. Pro: Heat stress as a potential etiology of Mesoamerican and Sri Lankan ne
42. phropathy: a late night consult with Sherlock Holmes. Nephrol Dial Transplant. 2017 Apr; 32(4): 598\u2013602.
43. Garc\u00eda-Trabanino R, et al. Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador\u2013A cross-shift study of workers at risk of Mesoamerican nephropathy. Environ Res. 2015 Oct; 142: 746\u201355.
44. Wesseling C, et al. Heat stress, hydration and uric acid: a cross-sectional study\u00a0in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua. BMJ Open. 2016 Dec; 6(12): e011034.
45. Solis Zepeda GA. Impacto de las medidas preventivas para evitar el deterioro de la\u00a0funci\u00f3n renal por el S\u00edndrome de Golpe por Calor en trabajadores agr\u00edcolas del Ingenio San Antonio del Occidente de Nicaragua, Ciclo Agr\u00edcola 2005\u20132006. Internal\u00a0Medicine Department. Le\u00f3n: Universidad Nacional Autonoma de Nicaragua; 2007.
46. Sorensen CJ, et al. Risk Factors and Mechanisms Underlying Cross-shift Decline in Kidney Function in Guatemalan Sugarcane Workers. J Occup Environ Med. 2019 Mar; 61(3): 239\u201350.
47. Fischer RS, et al. Clinical Evidence of Acute Mesoamerican Nephropathy. Am J Trop Med Hyg. 2017 Oct; 97(4): 1247\u201356.
48. Fischer RS, et al. Clinical markers to predict progression from acute to chronic kidney disease in Mesoamerican nephropathy. Kidney Int. 2018 Dec; 94(6): 1205\u201316.
49. Fischer RS, et al. Early detection of acute tubulointerstitial nephritis in the genesis of Mesoamerican nephropathy. Kidney Int. 2018 Mar; 93(3): 681\u2013 90.
50. Roncal Jimenez CA, et al. Fructokinase activity mediates dehydrationinduced renal injury. Kidney Int. 2014 Aug; 86(2): 294\u2013302.
51. Garc\u00eda-Arroyo FE, et al. Rehydration with soft drink-like beverages exacerbates dehydration and worsens dehydration-associated renal injury. Am J Physiol Regul Integr Comp Physiol. 2016 Jul; 311(1): R57\u201365.
52. Garc\u00eda-Arroyo FE, et al. Vasopressin Mediates the Renal Damage Induced by Limited Fructose Rehydration in Recurrently Dehydrated Rats. Int J Biol Sci. 2017 Jul; 13(8): 961\u201375.
53. Roncal-Jimenez C, et al. Heat Stress Nephropathy From Exercise-Induced Uric Acid Crystalluria: A Perspective on Mesoamerican Nephropathy. Am J Kidney Dis. 2016 Jan; 67(1): 20\u201330.
54. Roncal-Jimenez CA, Sato Y, Milagres T, Andres Hernando A, Garc\u00eda G, Bjornstad P, et al. Experimental heat stress nephropathy and liver injury are improved by allopurinol. Am J Physiol Renal Physiol. 2018 Sep; 315(3):F726\u2013 33.
55. S\u00e1nchez-Lozada LG,et al. Kidney Injury from Recurrent Heat Stress and Rhabdomyolysis: Protective Role of Allopurinol and Sodium Bicarbonate. Am J Nephrol. 2018; 48(5): 339\u201348.
56. Mix J, Elon L, Vi Thien Mac V, Flocks J, Economos E, Tovar-Aguilar AJ, et al. Hydration Status, Kidney Function, and Kidney Injury in Florida Agricultural Workers. J Occup Environ Med. 2018 May; 60(5):e253\u2013 60.
57. Moyce S, Mitchell D, Armitage T, Tancredi D, Joseph J, Schenker M. Heat strain, volume depletion and kidney function in California agricultural workers. Occup Environ Med. 2017 Jun; 74(6): 402\u20139.
58. Badurdeen Z, et al. Chronic kidney disease of uncertain etiology in Sri Lanka is a possible sequel of interstitial nephritis! Clin Nephrol. 2016; 86(13): 106\u20139.
59. Wijetunge S, et al. Endemic chronic kidney disease of unknown etiology in Sri Lanka: correlation of pathology with clinical stages. Indian J Nephrol. 2015 SepOct; 25(5): 274\u201380.
60. Mendoza-Gonz\u00e1lez MF, et al. . Prevalencia de Enfermedad Renal Cr\u00f3nica en una Poblaci\u00f3n de Alto Riego. Tierra Blanca, Veracruz, M\u00e9xico: Memorias Convenci\u00f3n Internacional de Salud P\u00fablica Havana, Cuba, Cuba Salud.; 2012.
61. Ganguli A. Uddanam Nephropathy\/Regional Nephropathy in India: Preliminary Findings and a Plea for Further Research. Am J Kidney Dis. 2016 Sep; 68(3): 344\u20138.
62. Stamatelou KK, et al. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int. 2003 May; 63(5): 1817\u201323.
63. Brikowski TH, Lotan Y, Pearle MS. Climaterelated increase in the prevalence of urolithiasis in the United States. Proc Natl Acad Sci USA. 2008 Jul; 105(28): 9841\u20136.
64. Borghi L, Meschi T, Amato F, Novarini A, Romanelli A, Cigala F. Hot occupation and nephrolithiasis. J Urol. 1993 Dec; 150(6): 1757\u201360.
65. Hooton TM,et al. Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial. JAMA Intern Med. 2018 Nov; 178(11): 1509\u201315.
66. Cirillo P, Gersch MS, Mu W, Scherer PM, Kim KM, Gesualdo L, et al. Ketohexokinasedependent metabolism of fructose induces proinflammatory mediators in proximal tubular cells. J Am Soc Nephrol. 2009 Mar; 20(3): 545\u201353.
67. Shoham DA,et al. Sugary soda consumption and albuminuria: results from the National Health and Nutrition Examination Survey, 1999-2004. PLoS One. 2008; 3(10):e3431.
68. Milagres T, et al. Rehydration with fructose worsens dehydration-induced renal damage. BMC Nephrol. 2018 Jul; 19(1): 180.
69. Roncal-Jimenez CA, et al. Effects of exogenous desmopressin on a model of heat stress nephropathy in mice. Am J Physiol Renal Physiol. 2017 Mar; 312(3):F418\u201326.
70. Chapman CL, Johnson BD, Sackett JR, Parker MD, Schlader ZJ. Soft drink consumption during and following exercise in the heat elevates biomarkers of acute kidney injury. Am J Physiol Regul Integr Comp Physiol. 2019 Mar; 316(3):R189\u201398.
71. Toloo GS, Fitzgerald G, Aitken P, Verrall K, Tong S. Are heat warning systems effective? Environ Health. 2013 Apr; 12(1): 27.
72. Mayrhuber EA, D\u00fcckers ML, Wallner P, Arnberger A, Allex B, Wiesb\u00f6ck L, et al. Vulnerability to heatwaves and implications for public health interventions \u2013 A scoping review. Environ Res. 2018 Oct; 166: 42\u201354.<\/p>\n\n\n\n

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\u017dem\u0117s temperat\u016bros kilimui pastaruoju metu skiriama labai daug d\u0117mesio. Nustatyta, kad per pastaruosius 50 met\u0173 m\u016bs\u0173 planetos pavir\u0161iaus temperat\u016bra pakilo apie 0,8\u00a0\u00b0C. Atrodyt\u0173, toks pakilimas n\u0117ra labai reik\u0161mingas, bet to pakanka sukelti didelius \u017emogaus sveikatos pakitimus\u00a0[1]. Vienas ry\u0161kiausi\u0173 padarini\u0173 b\u016bt\u0173 ekstremali\u0173 \u0161ilumini\u0173 \u012fvyki\u0173, vadinam\u0173 kar\u0161\u010dio bangomis, pagaus\u0117jimas [2\u20134]. Kar\u0161\u010dio bangos \u2013 da\u017eniausia vis\u0173 su orais…<\/p>\n","protected":false},"author":35,"featured_media":68840,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27314],"tags":[611],"site":[27309],"post_item_type":[27345],"class_list":["post-68837","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ekologija-ir-sveikata","tag-inkstai","site-imunitetas-lt"],"acf":{"post_sites":[27309]},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/68837","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/35"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=68837"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/68837\/revisions"}],"acf:term":[{"embeddable":true,"taxonomy":"site","href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site\/27309"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/68840"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=68837"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=68837"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=68837"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=68837"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=68837"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}