Climate change and the kidney

The worldwide increase in temperature has resulted in a marked increase in heat waves (heat extremes) that carries a markedly increased risk for morbidity and mortality. The kidney has a unique role not only in protecting the host from heat and dehydration but also is an important site of heat-associated disease. Here we review the potential impact of global warming and heat extremes on kidney diseases. High temperatures can result in increased core temperatures, dehydration, and blood hyperosmolality. Heatstroke (both clinical and subclinical whole-body hyperthermia) may have a major role in causing both acute kidney disease, leading to increased risk of acute kidney injury from rhabdomyolysis, or heat-induced inflammatory injury to the kidney. Recurrent heat and dehydration can result in chronic kidney disease (CKD) in animals and theoretically plays a role in epidemics of CKD developing in hot regions of the world where workers are exposed to extreme heat. Heat stress and dehydration also has a role in kidney stone formation, and poor hydration habits may increase the risk for recurrent urinary tract infections. The resultant social and economic consequences include disability and loss of productivity and employment. Given the rise in world temperatures, there is a major need to better understand how heat stress can induce kidney disease, how best to provide adequate hydration, and ways to reduce the negative effects of chronic heat exposure.Published versio

Surgical site infection in critically ill patients with secondary and tertiary peritonitis: epidemiology, microbiology and influence in outcomes

Background: Surgical site infection (SSI) remains a significant problem in the postoperative period that can negatively affect clinical outcomes. Microbiology findings are typically similar to other nosocomial infections, with differences dependent on microbiology selection due to antibiotic pressure or the resident flora. However, this is poorly understood in the critical care setting. We therefore aimed to assess the incidence, epidemiology and microbiology of SSI and its association with outcomes in patients with severe peritonitis in the intensive care unit (ICU). Methods: We prospectively studied 305 consecutive patients admitted to our surgical ICU from 2010 to 2014 with a diagnosis of secondary or tertiary peritonitis. We collected the following data: SSI diagnosis, demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II score, type of surgery, microbiology, antibiotic treatment and outcomes. Microbiological sampling was done by means of swabs. Results: We identified 269 episodes of SSI in 162 patients (53.1 %) aged 64.4 +/- 14.3 years, of which 200 episodes occurred in men (64.6 %). The mean APACHE II and SAPS II scores were 19.7 +/- 7.8 and 36.5 +/- 16.1 respectively. The mean ICU and hospital stays were 19.8 +/- 24.8 and 21.7 +/- 30 days respectively. Pseudomonas spp. (n = 52, 19.3 %), Escherichia coli (n = 55, 20.4 %) and Candida spp. (n = 46, 17.1 %) were the most frequently isolated microorganisms, but gram-positive cocci (n = 80, 29.7 %) were also frequent. Microorganisms isolated from SSIs were associated with a higher incidence of antibiotic resistance (64.9 %) in ICU patients, but not with higher in-hospital mortality. However, patients who suffered from SSI had longer ICU admissions (odds ratio = 1.024, 95 % confidence interval 1.010-1.039, P = 0.001). Conclusions: The incidence of SSI in secondary or tertiary peritonitis requiring ICU admission is very high. Physicians may consider antibiotic-resistant pathogens, gram-positive cocci and fungi when choosing empiric antibiotic treatment for SSI, although more studies are needed to confirm our results due to the inherent limitations of the microbiological sampling with swabs performed in our research. The presence of SSI may be associated with prolonged ICU stays, but without any influence on overall mortality

Outcomes of abdominal surgery in patients with liver cirrhosis

Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes. Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery. In the emergency setting, with the presence of decompensated LC, alcoholic hepatitis, severe/advanced LC, and significant extrahepatic organ dysfunction conservative management is preferred. A multidisciplinary, individualized, and specialized approach can improve outcomes; preoperative optimization after risk stratification and careful management are mandatory before surgery. Laparoscopic techniques can also improve outcomes. We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before, during, and after surgery

Hyperuricemia and chronic kidney disease: to treat or not to treat

Hyperuricemia is common in chronic kidney disease (CKD) and may be present in 50% of patients presenting for dialysis. Hyperuricemia can be secondary to impaired glomerular filtration rate (GFR) that occurs in CKD. However, hyperuricemia can also precede the development of kidney disease and predict incident CKD. Experimental studies of hyperuricemic models have found that both soluble and crystalline uric acid can cause significant kidney damage, characterized by ischemia, tubulointerstitial fibrosis, and inflammation. However, most Mendelian randomization studies failed to demonstrate a causal relationship between uric acid and CKD, and clinical trials have had variable results. Here we suggest potential explanations for the negative clinical and genetic findings, including the role of crystalline uric acid, intracellular uric acid, and xanthine oxidase activity in uric acid-mediated kidney injury. We propose future clinical trials as well as an algorithm for treatment of hyperuricemia in patients with CKD

Congruence of local ecological knowledge (LEK)-based methods and line-transect surveys in estimating wildlife abundance in tropical forests

Effective estimation of wildlife population abundance is an important component of population monitoring, and ultimately essential for the development of conservation actions. Diurnal line-transect surveys are one of the most applied methods for abundance estimations. Local ecological knowledge (LEK) is empirically acquired through the observation of ecological processes by local people. LEK-based methods have only been recognized as valid scientific methods for surveying fauna abundance in the last three decades. However, the agreement between both methods has not been extensively analysed. We compared concomitant abundance data for 91 wild species (mammals, birds and tortoises) from diurnal line transects (9,221 km of trails) and a LEK-based method (291 structured interviews) at 18 sites in Central and Western Amazonia. We used biological and socioecological factors to assess the agreements and divergences between abundance indices obtained from both methods. We found a significant agreement of population abundance indices for diurnal and game species. This relationship was also positive regardless of species sociality (solitary or social), body size and locomotion mode (terrestrial and arboreal); and of sampled forest type (upland and flooded forests). Conversely, we did not find significant abundance covariances for nocturnal and non-game species. Despite the general agreement between methods, line transects were not effective at surveying many species occurring in the area, with 40.2% and 39.8% of all species being rarely and never detected in at least one of the survey sites. On the other hand, these species were widely reported by local informants to occur at intermediate to high abundances. Although LEK-based methods have been long neglected by ecologists, our comparative study demonstrated their effectiveness for estimating vertebrate abundance of a wide diversity of taxa and forest environments. This can be used simultaneously with line-transect surveys to calibrate abundance estimates and record species that are rarely sighted during surveys on foot, but that are often observed by local people during their daily extractive activities. Thus, the combination of local and scientific knowledge is a potential tool to improve our knowledge of tropical forest species and foster the development of effective strategies to meet biodiversity conservation goals

Predicting animal abundance through local ecological knowledge: An internal validation using consensus analysis

Given the ongoing environmental degradation from local to global scales, it is fundamental to develop more efficient means of gathering data on species and ecosystems. Local ecological knowledge, in which local communities can consistently provide information on the status of animal species over time, has been shown to be effective. Several studies demonstrate that data gathered using local ecological knowledge (LEK)-based methods are comparable with data obtained from conventional methods (such as line transects and camera traps). Here, we employ a consensus analysis to validate and evaluate the accuracy of interview data on LEK. Additionally, we investigate the influence of social and bioecological variables on enhancing data quality. We interviewed 323 persons in 19 villages in the Western and Central Amazon to determine the level of consensus on the abundance of hunted and non-hunted forest species. These villages varied in size, socio-economic characteristics and in the experience with wildlife of their dwellers. Interviewees estimated the relative abundance of 101 species with a broad spectrum of bioecological characteristics using a four-point Likert scale. High consensus was found for species population abundance in all sampled villages and for 79.6% of interviewees. The village consensus of all species abundance pooled was negatively correlated with village population size. The consensus level was high regardless of the interviewees' hunting experience. Species that are more frequently hunted or are more apparent had greater consensus values; only two species presented a low consensus level, which are rare and solitary species. We show in our study in the Amazon that information gathered by local peoples, Indigenous as well as non-Indigenous, can be useful in understanding the status of animal species found within their environment. The high level of cultural consensus we describe likely arises from knowledge sharing and the strong connection between the persons interviewed and the forest. We suggest that consensus analysis can be used to validate LEK-generated data instead of comparing these types of data with information obtained by conventional methods

Predicting animal abundance through local ecological knowledge: An internal validation using consensus analysis

Given the ongoing environmental degradation from local to global scales, it is fundamental to develop more efficient means of gathering data on species and ecosystems. Local ecological knowledge, in which local communities can consistently provide information on the status of animal species over time, has been shown to be effective. Several studies demonstrate that data gathered using local ecological knowledge (LEK)‐based methods are comparable with data obtained from conventional methods (such as line transects and camera traps). Here, we employ a consensus analysis to validate and evaluate the accuracy of interview data on LEK. Additionally, we investigate the influence of social and bioecological variables on enhancing data quality. We interviewed 323 persons in 19 villages in the Western and Central Amazon to determine the level of consensus on the abundance of hunted and non‐hunted forest species. These villages varied in size, socio‐economic characteristics and in the experience with wildlife of their dwellers. Interviewees estimated the relative abundance of 101 species with a broad spectrum of bioecological characteristics using a four‐point Likert scale. High consensus was found for species population abundance in all sampled villages and for 79.6% of interviewees. The village consensus of all species abundance pooled was negatively correlated with village population size. The consensus level was high regardless of the interviewees' hunting experience. Species that are more frequently hunted or are more apparent had greater consensus values; only two species presented a low consensus level, which are rare and solitary species. We show in our study in the Amazon that information gathered by local peoples, Indigenous as well as non‐Indigenous, can be useful in understanding the status of animal species found within their environment. The high level of cultural consensus we describe likely arises from knowledge sharing and the strong connection between the persons interviewed and the forest. We suggest that consensus analysis can be used to validate LEK‐generated data instead of comparing these types of data with information obtained by conventional methods. Read the free Plain Language Summary for this article on the Journal blog