Role of heat shock proteins in renal function and adaptation to heat stress: Implications for global warming

The escalating global temperature, with 2024 as the hottest year, emphasizes the critical link between climate change and kidney health. Extreme heat, a consequence of global warming, causes multifaceted effects on human physiology, including renal function alterations. This review investigates physiological and molecular mechanisms of heat stress-induced kidney injury, including acute kidney injury, chronic kidney disease (CKD), and urinary stone formation. It highlights how heat stress contributes to renal dysfunction via dehydration, electrolyte imbalances, and activation of the renin-angiotensin-aldosterone system and antidiuretic hormone pathways, particularly in vulnerable populations like outdoor workers, the elderly, and pregnant women. The review also emphasizes the roles of heat shock proteins (HSPs)-HSP27, HSP60, HSP70, and HSP90-in maintaining cellular integrity by preventing protein aggregation and repairing damaged proteins in renal tissues. Dysregulation of these proteins under prolonged heat stress is implicated in CKD progression. This review highlights the urgent need for targeted public health interventions: (1) Hydration; (2) Workplace cooling; (3) Community education; and (4) Developing pharmacological therapies targeting HSPs. A multidisciplinary approach involving nephrology, environmental science, and public health is essential to mitigate the increasing burden of heat-related kidney disease in the era of global climate change.