Introduction
Burnt sugarcane harvesting is a hazardous and strenuous job that exposes workers to various health risks. An aggressive working environment, like exposure to air pollutants that originate from burnt sugarcane dust, causes various metabolic changes. It causes various problems like cardiorespiratory and metabolic changes, including increased blood pressure, increase in coagulability, autonomic imbalance, increase in oxidative stress, impaired lung function, and nasociliary clearance.
What Is Burnt Sugar Cane Harvesting?
Burnt sugarcane harvesting is a procedure performed for sugar production. It was performed for centuries in Latin America. Sugarcane field is burned to get rid of leaves and tops, as it impedes the harvest. This leaves only the sugar-bearing stalk, which is easier to harvest. This harvesting practice has a negative impact on health and causes various problems. This practice was largely discontinued throughout the world because of air pollution, but it is still followed by farmers in Florida. A new alternative called green harvest has been widely followed in recent times. It uses machines to clean the leaves and tops from the stalk before harvesting.
How Does Burnt Sugar Cane Harvesting Impact the Kidneys?
Burnt sugarcane harvesting is a hazardous job that exposes workers to various health problems because the workers are exposed to air pollutants produced from burnt sugarcane dust and at high ambient temperatures. The workers develop severe renal dysfunction due to extreme physical work that is associated with heat stress. The main mechanism behind acute renal dysfunction is dehydration and volume depletion, rhabdomyolysis, systemic inflammation, and oxidative stress.
Dehydration and Volume Depletion:
A clinical study was conducted to determine the mechanism behind renal dysfunction in burnt sugarcane harvesting workers. The study demonstrated that the amount of liquid ingested is very less during the work shift, and it is insufficient to replenish the water lost during the work. This causes an increase in urinary density at the end of their work shift. The workers also showed a decrease in urinary sodium levels and an increase in hematocrit values, suggesting an inappropriate liquid repositioning during the work shift. It is also associated with a decrease in serum sodium levels due to a high intake of water associated with increased sweating in a hot environment. This decrease in serum sodium aggravates intravascular volume depletion due to a decrease in plasma osmolality and is associated with increased serum creatinine kinase levels.
Rhabdomyolysis:
At the end of the daily shift, the workers showed a significant increase in creatinine kinase levels, which is an important marker for exertional rhabdomyolysis. Rhabdomyolysis is one of the factors that lead to the development of acute kidney injury in the presence of dehydration and hypovolemia. Rhabdomyolysis refers to the breakdown of muscle tissue which causes the release of myoglobin into the blood. Myoglobin causes damage to the kidneys. It is associated with intense muscle cramps in individuals developing acute kidney injury.
Systemic Inflammation and Oxidative Stress
The total number of white blood cells showed a significant increase from the beginning to the end of the work shift. This indicated the occurrence of an inflammatory burst due to the extremely strenuous work, high ambient temperatures, and acute muscle injury, which was enhanced by constant exposure to pollutants. Inflammation and inflammatory cells are associated with the development of acute kidney injury.
The workers showed an increase in the levels of serum malondialdehyde, which is a lipid peroxidation and oxidative stress marker. The increase in serum malondialdehyde is due to strenuous work and exposure to pollutants.
Other Factors:
The workers may take nonsteroidal anti-inflammatory drugs to alleviate pain. This can be an additional factor that causes kidney injury. Another factor responsible for acute kidney injury is cadmium. Cadmium is present in large quantities in burning biomass. Cadmium may lead to the development of acute kidney injury.
What Are the Signs and Symptoms of Acute Kidney Injury?
The following signs and symptoms are associated with acute kidney injury:
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Reduced urine output.
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Fluid retention causes swelling of legs, ankles, or feet.
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Shortness of breath.
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Confusion.
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Fatigue.
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Nausea.
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Weakness.
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Irregular heartbeat.
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Chest pain.
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Seizures in severe conditions.
What Are the Complications of Acute Renal Dysfunction Due to Burnt Sugarcane Harvesting?
Sugarcane harvesting causes complications like chronic kidney disease. Repeated episodes of acute kidney injury lead to the development of chronic kidney disease, which was referred to as “mesoamerican nephropathy.” Recurrent episodes of acute kidney injury associated with dehydration, volume depletion, pollutants exposure, and rhabdomyolysis lead to the development of mesoamerican nephropathy.
How Can Acute Renal Dysfunction Due to Burnt Sugarcane Harvesting Be Prevented?
The following strategies help in the prevention of heat stress-induced injuries:
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Water and salt reposition instead of drinking plain water.
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Appropriate clothing to work in an environment with high ambient temperatures.
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Limiting the working hours.
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The use of alcohol, illicit drugs, and nonsteroidal anti-inflammatory drugs should be avoided.
How Is Acute Renal Dysfunction Diagnosed?
The diagnosis of acute kidney injury depends on the following tests:
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Urine Output Measurement - 24-hour urine output is measured to determine the cause of renal failure.
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Urinalysis - A urine sample is analyzed to determine the abnormalities associated with renal failure.
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Radiographic Imaging - Radiographic imaging tests like ultrasound and computerized tomography are performed to visualize the kidneys.
How Is Acute Renal Dysfunction Treated?
The treatment for acute renal dysfunction is based on the treatment for the underlying cause of kidney injury. The sugarcane harvesters should adequately hydrate themselves to prevent dehydration and limit their working hours. The treatment procedures include the following:
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Intravenous fluids are given to manage the volume depletion. In some cases, diuretics are required to expel the extra fluids that cause swelling in the arms and legs.
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Medications are given to control the potassium levels, as renal dysfunction causes a decrease in the removal of excess potassium.
Chronic kidney disease associated with burnt sugarcane harvesting may require renal replacement therapy and renal transplantation.
Conclusion
Burnt sugarcane harvesting is a hazardous job that causes various health problems. It has been widely discontinued all over the world, but it is still followed in some places. Limiting exposure to such an environment can prevent this disease. Early diagnosis and treatment are essential to prevent the progression of the disease.
