Acute Renal Dysfunction Linked to Sugarcane Harvesting

The association stems from performing physically overwhelming work in an unhealthy environment.
The association stems from performing physically overwhelming work in an unhealthy environment.

Researchers have found that harvesting burnt sugarcane can cause acute renal dysfunction in healthy workers, according to a recent report.

Ubiratan Paula Santos, MD, of the University of São Paulo Medical School in São Paulo, Brazil, and colleagues evaluated the acute effects of harvesting burnt sugarcane on 28 healthy workers. They collected urine and blood samples at the beginning and at the end of the harvesting season and before and at the end of a harvesting workday.

All subjects experienced decreases in their estimated glomerular filtration rate by about 20% at the end of the daily shift, and 18.5% of the workers presented with serum creatinine increases consistent with acute kidney injury (AKI), Dr. Santos' group reported online ahead of print in Kidney International.

“The observed kidney injury was associated with a combination of dehydration, hypovolemia, rhabdomyolysis, systemic inflammation, and oxidative stress, which were likely caused by performing prolonged, physically overwhelming work in an unhealthy environment,” the authors concluded.

Dr. Santo's team found that workers, during their shift, experienced increased serum creatine phosphokinase (a known marker for exertional rhabdomyolysis), oxidative stress-associated malondialdehyde levels, increased peripheral blood white cell counts, decreased urinary and serum sodium, decreased calculated fractional sodium excretion, and increased urine density.

“The significant increase in urinary density at the end of the work shift suggest that the amount of liquid ingested was likely not sufficient to replenish the water that was lost,” the investigators wrote.

In fact, the individuals who developed AKI had marginally significant lower levels of post-work shift urinary sodium and fractional excretion of sodium and a significantly greater increase in hematocrit, “reinforced the supposition that an inappropriate liquid reposition most likely occurred during the workday.”

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