Rising heat, failing kidneys: Heat stress nephropathy in climate crisis

Climate change is driving increasing global temperatures and extreme heat events, with significant health implications worldwide. Heat stress nephropathy (HSN) is emerging as a concerning renal disorder, particularly in South Asia, where rising temperatures combine with occupational heat exposure and inadequate hydration to create conditions conducive to kidney injury. This review examines HSN pathophysiology, prevalence in South Asian countries, region-specific risk factors, and preventive strategies. The multifactorial etiology of HSN—involving recurrent dehydration, heat exposure, potential environmental toxins, and sociocultural factors—creates unique challenges for South Asian populations. Distinctive clinical features include minimal proteinuria, a tubulointerstitial injury pattern, and predominance in agricultural workers. As climate projections indicate continued warming trends for the region, implementing effective preventive measures becomes increasingly critical. These include occupational safeguards, improved hydration practices, early detection programs, public health initiatives, and broader climate adaptation strategies. The development of targeted interventions addressing the unique pathophysiology and socioeconomic context of HSN in South Asia is essential for mitigating its growing burden amid climate change.