New insight into solvent-related end-stage renal disease: occupations, products and types of solvents at risk

Abstract

Objectives:It has been shown that all-solvent exposure is associated with the progression of primary glomerulonephritis to end-stage renal disease (ESRD), but little is known about the type of solvents that are high risk. The aim of this study was to investigate the role of solvents by occupation, product and type.Methods:Using a retrospective cohort design, the authors studied 269 patients with non-end-stage and biopsy-proven primary glomerulonephritis diagnosed between 1994 and 2001 in Paris and its suburbs. Two industrial hygienists evaluated patients’ exposures from lifetime occupational histories collected by interview from 2002–4, and using a list of the 30 most common solvents. The studied outcome was ESRD, defined as glomerular filtration rate <15 ml/mn/1.73 m2or dialysis. It was recorded during a mean follow-up of five years. Cox models were used to estimate adjusted hazard ratios (HR) of ESRD related to exposures.Results:Eighteen per cent of the patients had ever been exposed to solvents. Those with the highest risk of progression to ESRD were exposed machinery fitters and machine assemblers (HR 4.7, 95% CI 1.2 to 17.4) and plumbers/welders (HR 4.2, 95% CI 1.3 to 13.6), as compared to never exposed patients, as well as those who ever handled printing inks and petroleum products (HR 12.6 (95% CI 1.7 to 94.9) and 3.2 (95% CI 1.4 to 7.2), respectively). Among solvents, the highest risks were found for: toluene/xylene (HR 5.1, 95% CI 1.8 to 14.8), gasoline, fuel and gas-oil (HR 8.6, 95% CI 2.7 to 27.4), and ketones (HR 13.3, 95% CI 1.4 to 123.5).Conclusion:This study highlights the potential nephrotoxicity of several solvents. Intervention to promote screening for proteinuria in exposed workers may prevent the progression of glomerulonephritis to ESRD.

IgA nephropathy in a laboratory worker that progressed to end-stage renal disease: a case report

“… ·There was a trend increasing HR with exposure duration before and its persistence after diagnosis. Jacob et al [ 13 ] (2007) retrospective cohort study 269 patients with non-ESRD and biopsy-proven primary GN a diagnosis between 1994 and 2001 in Paris and suburbs (including 167 IgAN patients) aggravation of IgAN to ESRD 2002–2004 269/167 ·This study showed the potential role of toluene and xylene, some petroleum products, ketones and possibly dichloromethane in the progression of GN a to ESRD. a GN, Glomerulonephritis; b RR, Relative Risk; c OR, Odds Ratio; d HR, Hazard Ratio; e (··), 95 % Confidence Interval …”

“…In a subsequent study, using data from the GN-PROGRESS cohort, Jacob et al [ 13 ] therefore systematically investigated the risk of progression to ESRD, by solvent-exposed job category, type of solvent-containing products, and by solvent or solvent family. In this analysis [ 13 ], they focused on the 269 patients with either IgAN or membranous nephropathy. Among solvents, the highest risks were found for: toluene/xylene (HR = 5.1, 95 CI 1.8–14.8), gasoline, fuel and gas-oil (HR = 8.6, 95 CI 2.7–27.4), and ketones (HR = 13.3, 95 % CI 1.4–123.5).…”

“…Among solvents, the highest risks were found for: toluene/xylene (HR = 5.1, 95 CI 1.8–14.8), gasoline, fuel and gas-oil (HR = 8.6, 95 CI 2.7–27.4), and ketones (HR = 13.3, 95 % CI 1.4–123.5). Most interestingly, they also observed an excess risk for any exposure level to methylene chloride, also known as dichloromethane (HR = 6.4, 95 % CI 1.7–24.8) [ 13 ]. In another occupational cohort study in US aircraft workers, Radican et al [ 30 ] pointed to the risk of all-cause ESRD associated with trichloroethylene, 1,1,1-trichlorethane, dichloromethane, and JP4 gasoline.…”

“…Although the etiology and pathophysiology of IgAN have not yet been clearly identified, accumulating evidence suggests that the onset and progression are caused by interactions between various genetic and environmental factors [ 6 – 9 ]. Among them, occupational risk factors such as exposure to organic solvents have been suggested as probable causes that may induce [ 7 , 8 , 10 ] or aggravate IgAN [ 11 – 13 ].…”

Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study

“…Cross-sectional studies of workers chronically exposed to toluene and other organic solvents found an increased urinary albumin excretion compared to controls [ 50 ]. Among industrial solvents, toluene exposure was found to confer the greatest risk for progression to end-stage renal disease in patients with established glomerulonephritis [ 29 ]. Toluene has also been associated to direct induction of acute tubular necrosis and acute oliguric renal failure [ 25 ].…”