Pai P, Hindell P, Stevenson A, Mason H, Bell GM
Occupational hydrocarbon exposure and nephrotoxicity
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1340 1996
Occupation as a cause of renal disease is often overlooked by
clinicians. We may remember about exposure to metals but neglect other
nephrotoxins, such as solvents (CCl4, toluene, and chloroethylenes are
known to injure the kidneys). The role of hydrocarbons is still
unclear except for possible hydrocarbon- induced lung injury as the
initiating event of Goodpasture's syndrome. This study looked at
groups of car sprayers exposed to hydrocarbons, one of which had a
longer history of respiratory protection, and compared various
parameters of renal function. Internal controls worked at the same
plants without being exposed to hydrocarbons.
Both groups of exposed workers had a tenfold higher prevalence of
elevated creatinine and proteinuria than controls; interestingly, the
protein was not albumin. The authors used the 8% prevalence of
elevated urinary NAG (a lysozyme) in the group with lesser protection,
compared to 2.1% in the workers with longer protection, to argue that
protection may prevent renal injury.
Comment: There are problems with the abstract:
- The workers were exposed to many different hydrocarbons, and no
attempt was made to determine which ones were more likely to produce
injury.
- The level of proteinuria considered significant is not mentioned.
- No explanation is given for the higher prevalence of azotemia in
the group with more protection.
- NAG is a very nonspecific test of renal dysfunction.
Nonetheless, the study suggests that we should be taking better
occupational histories and looking more seriously into environmental
causes of renal failure.
(Don Feinfeld MD, State University of New York at Stony
Brook)
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Am Soc Nephrol
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