2) Follow this 🧵to earn🆓 CE/#CME courtesy of the collaboration of @ckd_ce and @Kidney_int.
— @CKD_ce (@ckd_ce) October 2, 2023
Faculty disclosures at https://t.co/PHlIppl6Yw. For more 🆓credit, 👉#blogposts edited by @sophia_kidney at https://t.co/Zap2Al75YO.#FOAMed @MedTweetorials @ISNkidneycare
4) It's d, all of the above.#Heat stress causes more 🪦worldwide than any other weather-related cause!
— @CKD_ce (@ckd_ce) October 2, 2023
And uh oh, according to World Meteorological Organisation @WMO, the 🌐 average temp for July 2023 was the highest on record for 120,000 yrs!! 🔥https://t.co/fdZ8e2M8qO
6) The human body’s heat balance is determined by climactic factors:
— @CKD_ce (@ckd_ce) October 2, 2023
Air temperature 🌡️
Radiant temperature ☀️
Humidity 💧
Air movement 💨
&
Non-climatic factors:
Clothing👚
Metabolic heat during physical activity 🫠https://t.co/deKR1NBCTO pic.twitter.com/h1mvQNTFER
8) Theories linking #Mesoamerican #nephropathy or #CKDu (unknown etiology) to heat stress include:
— @CKD_ce (@ckd_ce) October 2, 2023
🔥 Recurrent #dehydration
🔥 #Hyperuricemia
🔥 #Urolithiaisis
🔥 Subclinical #rhabdomyolysis
🔥 #Fructose-containing drinks ➡️ #oxidativestresshttps://t.co/nz1Lh8H9N5 pic.twitter.com/yWd5pxCchE
10) Let’s discuss to get to the answer!#RAS in heat stress nephropathy:
— @CKD_ce (@ckd_ce) October 2, 2023
☀️Heat stress➡️🔼 Sympathetic nervous system ➡️ 🔼RAS 🔽renal blood flow (RBF)🔼 H₂O and Na⁺ absorption➡️ 🔼 renal O₂ demand
☀️🔼RAS ➡️ K⁺ loss ➡️hypokalemic nephropathy
12)
— @CKD_ce (@ckd_ce) October 2, 2023
💊NSAID for bodyache➡️🔽#prostaglandin➡️ 🔽 RBF
🔶🔼UA (dehydration+muscle injury+fructose)➡️🔽NO➡️🔽 RBF
🦠Heat stress➡️🔽gut perfusion➡️🔼increased permeability ➡️release of bacterial endotoxins➡️proinflammatory cytokines
So, the answer is for post 9 ☝️is c, #ROS! pic.twitter.com/dZx6kGCkJL
14) Heat stress is a health hazard in non-agricultural settings as well, such as
— @CKD_ce (@ckd_ce) October 2, 2023
♨️Construction 🏗️
♨️Transportation 🚛
♨️Steel plants
♨️Work near furnaces, ovens, smelters
♨️Boilers in kitchens
♨️Foundries
♨️Automobile industries 🚗
♨️Glass manufacturing units
♨️Salt pan workers
16a) Methods:
— @CKD_ce (@ckd_ce) October 2, 2023
⏲️Cross-sectional study
🇮🇳 7 salt pans in Tamil Nadu, India
🗓️ Summer (April–July) & winter (October–January) seasons between 2017 & 2020
👥Convenience sampling, n =352
16c) Wait: what is wet bulb globe temp #WBGT ??
— @CKD_ce (@ckd_ce) October 2, 2023
🌡️Developed in 1950’s to prevent heat casualties occurring in US armed forces
🌡️Uses ambient temperature, humidity, wind, solar radiation
🌡️To monitor environmental conditions during exercise🏃https://t.co/snu5udE81L
18) Results:
— @CKD_ce (@ckd_ce) October 2, 2023
❓Answers to questionnaire
93% reported at least 1 heat-strain symptom 🫠
59% had dry mouth or excessive thirst 🥵
Median water consumption was 1 litre 🚰
23% women said they would drink ⬆️water if they had 🚾access
20)
— @CKD_ce (@ckd_ce) October 2, 2023
🥵Calculated Sweat rate >1l /h in 48%
💧Urine specific gravity ≥1.020 in 10.1% (pre-shift) & 28% (post-shift)
👂 Tympanic membrane temp⬆️ ≥1°C in 15% (pre to post-shift)
♥️ Post shift heart rate >100 in 4%
⬇️ eGFR < 90ml/min- 47 % (56% ♂️ 38%♀️)
⬇️ eGFR <60- 7%
22a) One more quiz question: Which of the following is NOT a feature typically associated with heat stress nephropathy?
— @CKD_ce (@ckd_ce) October 2, 2023
a. low-grade proteinuria
b. ⬆️urine spec gravity
c. hematuria
d. ⬇️#eGFR
22c) Markers of heat stress nephropathy include low-grade proteinuria, progressive kidney failure assoc'd with #tubulointerstitial disease & #glomerulosclerosis, per https://t.co/femaoH62nD.
— @CKD_ce (@ckd_ce) October 2, 2023
24) Let’s recap by admiring the beautiful #visualabstract by @md_abdulqader83 pic.twitter.com/0aoDIZtW5i
— @CKD_ce (@ckd_ce) October 2, 2023
26) This is @DrPallaviPrasad from Pod-o-cyte signing off! Thanks @NSMCinternship, all faculty members @brian_rifkin @md_abdulqader83 @sophia_kidney @ghobby @nephroseeker for your guidance. Thanks @Kireports @ISNkidneycare @ckd_ce @academiccme for the opportunity!
— @CKD_ce (@ckd_ce) October 2, 2023