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Oliveira RBD, Barreto FC, Nunes LA, Custódio MR. Aluminum Intoxication in Chronic Kidney Disease. J Bras Nefrol 2021; 43:660-664. [PMID: 34910802 PMCID: PMC8823919 DOI: 10.1590/2175-8239-jbn-2021-s110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rodrigo Bueno de Oliveira
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Serviço de Nefrologia, Campinas, SP, Brasil
| | - Fellype Carvalho Barreto
- Universidade Federal do Paraná, Complexo do Hospital de Clínicas, Serviço de Nefrologia, Curitiba, PR, Brasil
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2
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Rocha LAD, Neves MCD, Montenegro FLDM. Parathyroidectomy in chronic kidney disease. J Bras Nefrol 2021; 43:669-673. [PMID: 34910804 PMCID: PMC8823920 DOI: 10.1590/2175-8239-jbn-2021-s112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Murilo Catafesta das Neves
- Universidade Federal de São Paulo, Head and Neck Surgery Discipline, Otorhinolaryngology and Head & Neck Surgery Department, São Paulo, SP, Brazil
| | - Fabio Luiz de Menezes Montenegro
- Universidade de São Paulo, Faculdade de Medicina, Central Institute of Hospital das Clínicas, Head and Neck Surgery Division, São Paulo, SP, Brazil
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Rony L, Pascaretti-Grizon F, Hubert L, Chappard D. Histochemical identification of wear debris released by alumina-on-alumina hip prostheses in the periprosthetic tissues. Orthop Traumatol Surg Res 2021; 107:102636. [PMID: 33023845 DOI: 10.1016/j.otsr.2020.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tribological studies have shown that the most used couples for hip prostheses consist of metal-on-polyethylene and alumina-on-alumina prostheses. Over time, wear products accumulate in the joint cavity and in the periprosthetic tissues. Although polyethylene and metal are easily identifiable by microscopy in periprosthetic tissues, alumina particles are very difficult to identify. HYPOTHESIS The fluorescent azo-dye lumogallion was evaluated as a suitable histochemical stain for alumina particles in periprosthetic tissues. MATERIAL AND METHOD In 28 patients who had a prosthetic revision of an alumina-on-alumina prosthesis, periprosthetic tissues were removed and embedded in paraffin; sections were stained with HPS (for conventional diagnosis) or with lumogallion. Sections were examined for wear particles in light and fluorescence microscopy. Some sections were counter-stained using DAPI for visualization of cell nuclei. RESULTS The wear particles of the alumina-alumina prostheses were very difficult to identify on the HPS stained sections; they were clearly evidenced by lumogallion staining with a bright orange fluorescence. The stain revealed large quantities of particles (of the order of several thousand per section). Only two patients had no particles. The staining technique identified numerous particles that were not visible on HPS-stained sections in macrophages, synoviocytes and fibroblasts. CONCLUSION This staining, which has been validated in neuromuscular pathology for the identification of alumina used as a vaccine adjuvant, gave successful results in the present study. Alumina particles are modified when they are phagocytized by macrophages. lumogallion staining easily shows the presence of thousands of wear particles released by alumina-on-alumina prostheses in periprosthetic tissues. LEVEL OF EVIDENCE V expert opinion study.
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Affiliation(s)
- Louis Rony
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France; Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France
| | - Florence Pascaretti-Grizon
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France
| | - Laurent Hubert
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France; Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France
| | - Daniel Chappard
- Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France.
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4
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Meira RDD, Carbonara CEM, Quadros KRDS, Santos CUD, Schincariol P, Pêssoa GDS, Arruda MAZ, Jorgetti V, Oliveira RBD. The enigma of aluminum deposition in bone tissue from a patient with chronic kidney disease: a case report. ACTA ACUST UNITED AC 2018; 40:201-205. [PMID: 29927461 PMCID: PMC6533990 DOI: 10.1590/2175-8239-jbn-3882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/24/2017] [Indexed: 11/21/2022]
Abstract
About four decades ago, the relationship between dialysis-dementia and aluminum (Al) began to be established. The restriction of drugs containing Al and improvements on water quality used for dialysis resulted in the clinical disappearance of Al intoxication. However, high prevalence of Al deposition in bone tissue from Brazilian dialysis patients is still being detected. Through the case report of a patient on hemodialysis (HD) for one year, presenting significant Al deposition in bone tissue, we speculated if this problem is not being underestimated. We used extensive investigation to identify potential sources of Al exposure with a careful review of medication history and water quality controls. Al concentration was measured by different methods, including mass spectrometry, in poly-electrolyte concentrate solutions and solution for peritoneal dialysis, in an attempt to elucidate the possible sources of contamination. The objective of this case report is to alert the medical community about a potential high prevalence of Al deposition in bone tissue and to discuss the possible sources of contamination in patients with chronic kidney disease (CKD).
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Affiliation(s)
- Rodrigo Dias de Meira
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil
| | - Cinthia Esbrile Moraes Carbonara
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil.,Universidade Estadual de Campinas, Departamento de Medicina Interna (Nefrologia) - Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia (LEMON), Campinas, SP, Brasil
| | - Kélcia Rosana da Silva Quadros
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil.,Universidade Estadual de Campinas, Departamento de Medicina Interna (Nefrologia) - Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia (LEMON), Campinas, SP, Brasil
| | - Carolina Urbini Dos Santos
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil
| | - Patrícia Schincariol
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil
| | - Gustavo de Souza Pêssoa
- Universidade Estadual de Campinas, Instituto de Química, Grupo de Espectrometria, Preparo de Amostras e Mecanização, Departamento de Química Analítica, Campinas, SP, Brasil
| | - Marco Aurélio Zezzi Arruda
- Universidade Estadual de Campinas, Instituto de Química, Grupo de Espectrometria, Preparo de Amostras e Mecanização, Departamento de Química Analítica, Campinas, SP, Brasil
| | - Vanda Jorgetti
- Universidade de São Paulo, Departamento de Medicina Interna, São Paulo, SP, Brasil
| | - Rodrigo Bueno de Oliveira
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brasil.,Universidade Estadual de Campinas, Departamento de Medicina Interna (Nefrologia) - Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia (LEMON), Campinas, SP, Brasil
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5
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Busser B, Moncayo S, Trichard F, Bonneterre V, Pinel N, Pelascini F, Dugourd P, Coll JL, D'Incan M, Charles J, Motto-Ros V, Sancey L. Characterization of foreign materials in paraffin-embedded pathological specimens using in situ multi-elemental imaging with laser spectroscopy. Mod Pathol 2018; 31:378-384. [PMID: 29148536 DOI: 10.1038/modpathol.2017.152] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 12/15/2022]
Abstract
Pathologists typically encounter many disparate exogenous materials in clinical specimens during their routine histopathological examinations, especially within the skin, lymph nodes, and lungs. These foreign substances may be free extracellular deposits or induce several clinical abnormalities or histopathological patterns. However, pathologists almost never investigate or report the chemical nature of exogenous metals in clinical specimens due to a lack of convenient and available technologies. In this paper, a novel strategy based on laser-induced breakdown spectroscopy (LIBS) technology is evaluated for in situ multi-elemental tissue imaging. The improved procedures allow visualization of the presence of chemical elements contained within paraffin-embedded specimens of medical interest with elemental images that are stackable with conventional histology images. We selected relevant medical situations for which the associated pathology reports were limited to the presence of lymphohistiocytic and inflammatory cells containing granules (a granuloma and a pseudolymphoma) or to lymph nodes or skin tissues containing pigments or foreign substances. Exogenous elements such as aluminum, titanium, copper, and tungsten were identified and localized within the tissues. The all-optical LIBS elemental imaging instrument that we developed is fully compatible with conventional optical microscopy used for pathology analysis. When combined with routine histopathological analysis, LIBS is a versatile technology that might help pathologists establish or confirm diagnoses for a wide range of medical applications, particularly when the nature of external agents present in tissues needs to be investigated.
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Affiliation(s)
- Benoit Busser
- Institute for Advanced Biosciences, UGA/Inserm U 1209/CNRS UMR 5309 joint research center, Grenoble, France.,Grenoble Alpes University Hospital, Grenoble, France.,Institut Lumière Matière, UMR 5306, Université Claude Bernard Lyon 1, CNRS, Villeurbanne, France
| | - Samuel Moncayo
- Institut Lumière Matière, UMR 5306, Université Claude Bernard Lyon 1, CNRS, Villeurbanne, France
| | - Florian Trichard
- Institut Lumière Matière, UMR 5306, Université Claude Bernard Lyon 1, CNRS, Villeurbanne, France
| | | | - Nicole Pinel
- Grenoble Alpes University Hospital, Grenoble, France
| | | | - Philippe Dugourd
- Institut Lumière Matière, UMR 5306, Université Claude Bernard Lyon 1, CNRS, Villeurbanne, France
| | - Jean-Luc Coll
- Institute for Advanced Biosciences, UGA/Inserm U 1209/CNRS UMR 5309 joint research center, Grenoble, France
| | - Michel D'Incan
- University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Julie Charles
- Institute for Advanced Biosciences, UGA/Inserm U 1209/CNRS UMR 5309 joint research center, Grenoble, France.,Grenoble Alpes University Hospital, Grenoble, France
| | - Vincent Motto-Ros
- Institut Lumière Matière, UMR 5306, Université Claude Bernard Lyon 1, CNRS, Villeurbanne, France
| | - Lucie Sancey
- Institute for Advanced Biosciences, UGA/Inserm U 1209/CNRS UMR 5309 joint research center, Grenoble, France
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6
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Chappard D, Bizot P, Mabilleau G, Hubert L. Aluminum and bone: Review of new clinical circumstances associated with Al(3+) deposition in the calcified matrix of bone. Morphologie 2016; 100:95-105. [PMID: 26762722 DOI: 10.1016/j.morpho.2015.12.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 11/26/2022]
Abstract
Several decades ago, aluminum encephalopathy associated with osteomalacia has been recognized as the major complication of chronic renal failure in dialyzed patients. Removal of aluminum from the dialysate has led to a disappearance of the disease. However, aluminum deposit occurs in the hydroxyapatite of the bone matrix in some clinical circumstances that are presented in this review. We have encountered aluminum in bone in patients with an increased intestinal permeability (coeliac disease), or in the case of prolonged administration of aluminum anti-acid drugs. A colocalisation of aluminum with iron was also noted in cases of hemochromatosis and sickle cell anemia. Aluminium was also identified in a series of patients with exostosis, a frequent benign bone tumor. Corrosion of prosthetic implants composed of grade V titanium (TA6V is an alloy containing 6% aluminum and 4% vanadium) was also observed in a series of hip or knee revisions. Aluminum can be identified in undecalcified bone matrix stained by solochrome azurine, a highly specific stain allowing the detection of 0.03 atomic %. Colocalization of aluminum and iron does not seem to be the fruit of chance but the cellular and molecular mechanisms are still poorly understood. Histochemistry is superior to spectroscopic analyses (EDS and WDS in scanning electron microscopy).
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Affiliation(s)
- D Chappard
- Groupe études remodelage osseux et biomatériaux (GEROM), LHEA, IRIS-IBS institut de biologie en santé, CHU d'Angers, LUNAM université Nantes Angers Le Mans, 49933 Angers cedex, France; Service commun d'imagerie et analyses microscopiques (SCIAM), IRIS-IBS institut de biologie en santé, CHU d'Angers, LUNAM université, 49933 Angers cedex, France.
| | - P Bizot
- Département de chirurgie osseuse, CHU d'Angers, 49933 Angers cedex, France
| | - G Mabilleau
- Groupe études remodelage osseux et biomatériaux (GEROM), LHEA, IRIS-IBS institut de biologie en santé, CHU d'Angers, LUNAM université Nantes Angers Le Mans, 49933 Angers cedex, France; Service commun d'imagerie et analyses microscopiques (SCIAM), IRIS-IBS institut de biologie en santé, CHU d'Angers, LUNAM université, 49933 Angers cedex, France
| | - L Hubert
- Département de chirurgie osseuse, CHU d'Angers, 49933 Angers cedex, France
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7
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Chappard D, Mabilleau G, Moukoko D, Henric N, Steiger V, Le Nay P, Frin JM, De Bodman C. Aluminum and iron can be deposited in the calcified matrix of bone exostoses. J Inorg Biochem 2015; 152:174-9. [DOI: 10.1016/j.jinorgbio.2015.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/02/2015] [Accepted: 09/14/2015] [Indexed: 11/26/2022]
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8
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Barreto FC, Araújo SMHA. Intoxicação alumínica na DRC. J Bras Nefrol 2011. [DOI: 10.1590/s0101-28002011000200016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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9
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Walton JR, Diamond TH, Kumar S, Murrell GAC. A sensitive stain for aluminum in undecalcified cancellous bone. J Inorg Biochem 2007; 101:1285-90. [PMID: 17664014 DOI: 10.1016/j.jinorgbio.2007.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 06/01/2007] [Accepted: 06/01/2007] [Indexed: 10/23/2022]
Abstract
Aluminum is known to accumulate with age in bone and other tissues of humans, even in the absence of renal disease. Our study aimed to develop a histological staining method sufficiently sensitive to detect aluminum in plastic sections of undecalcified bone biopsies from healthy volunteers as well as from patients with renal and non-renal bone diseases. We used quantitative histomorphometry to measure the percentage of trabecular surface stained by aluminum and found that our new method was approximately 50% more sensitive for detecting aluminum than the Acid Solochrome Azurine (ASA) method which in turn was significantly more sensitive than the Aluminon method. Aluminon is widely used in pathology laboratories for diagnostic purposes despite concerns in the literature about Aluminon's limited sensitivity for aluminum. Our histomorphometric results showed that the newly developed method stained approximately 10% of the trabecular surface in bone sections from healthy controls, 38% from renal patients, 26% from patients with vitamin D deficiency, and 29% from patients with osteoporosis. Histomorphometric measurements of aluminum-stained trabecular surfaces in sections stained with ASA were consistent with those obtained in Walton-stained sections but proportionately lower. Moreover, the Walton and ASA methods stained aluminum at similar locations in adjacent bone sections. As the ASA and Walton methods are considerably more sensitive for bone aluminum than the Aluminon method, we recommend that either of them should be used in place of the Aluminon method for routine diagnostic purposes.
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Affiliation(s)
- J R Walton
- Department of Orthopaedic Surgery, University of New South Wales, St George Hospital Campus, Sydney NSW 2217, Australia.
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10
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Lehmann G, Stein G, Hüller M, Schemer R, Ramakrishnan K, Goodman WG. Specific measurement of PTH (1-84) in various forms of renal osteodystrophy (ROD) as assessed by bone histomorphometry. Kidney Int 2005; 68:1206-14. [PMID: 16105052 DOI: 10.1111/j.1523-1755.2005.00513.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Parathyroid hormone (PTH) measurements serve as a noninvasive, diagnostic tool for the assessment of renal osteodystrophy (ROD). Their value has been questioned following reports indicating that all commercially available intact PTH (I-PTH) assays cross-react with amino terminally truncated PTH fragments. Because these fragments can account for 50% of total PTH, their detection will overestimate the true PTH concentration and may lead to diagnostic inaccuracies. The aim of this study was to evaluate the specific Bio-Intact PTH (1-84) Assay (BI-PTH) in patients with various types of ROD confirmed by bone biopsy. METHODS Bone biopsies were taken from 132 patients with chronic kidney disease (CKD) stages 3 to 5, and quantitative bone histomorphometry was done. Plasma PTH levels were measured using both the BI-PTH and I-PTH assays on an automated analyzer. RESULTS Patients with CKD stages 3/4 and low turnover skeletal lesions had BI-PTH values (pg/mL, mean +/- SD) of 35 (+/-34) and I-PTH values of 59 (+/- 63). Corresponding values for BI-PTH and I-PTH in those with high turnover lesions were 141 (+/-60) and 221 (+/-106). Patients with CKD stage 5 and low turnover skeletal lesions had BI-PTH and I-PTH levels of 51 (+/-38) and 90 (+/-60), respectively, whereas the corresponding results for BI-PTH and I-PTH in those with high turnover lesions were 237 (+/-214) and 461 (+/-437). The areas under the receiver operating characteristic (ROC) curves for distinguishing low turnover from high turnover lesions were 0.94 for BI-PTH and 0.91 for I-PTH in CKD stages 3/4 and 0.86 for BI-PTH and 0.85 for I-PTH in CKD stage 5. Among all patients, BI-PTH levels are approximately 50% lower than I-PTH levels, but the results of the two assays are correlated highly (R2 = 0.92). CONCLUSION Plasma PTH measurements using either the BI-PTH or I-PTH assay effectively identify patients with reduced bone turnover and serve to distinguish this subgroup from those with high turnover lesions of renal bone disease. Both assays provide better diagnostic discrimination for this purpose than calculated values for the ratio of PTH (1-84)/amino terminally truncated PTH fragments.
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Affiliation(s)
- Gabriele Lehmann
- Division of Rheumatology and Osteology, Department of Internal Medicine III, Friedrich-Schiller University of Jena, Jena, Germany.
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Affiliation(s)
- Stephan R Orth
- Division of Nephrology and Hypertension, University Hospital Berne (Inselspital), Berne, Switzerland.
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12
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Abstract
Smoking is a known risk factor for cardiovascular diseases, cancer, and several other health problems. It is the number one preventable cause of death in modern countries. The first evidence that smoking may be a renal risk factor was published in 1978. Since then, several studies documented that smoking is nephrotoxic in patients with diabetic and non-diabetic renal disease. Data from the Multiple Risk Factor Intervention Trial indicate that smoking even increases the renal risk in the general male population: an increased relative risk for end-stage renal failure (ESRF) was found for smokers as compared to non-smokers (up to 1.69 for heavy smokers). Several potential mechanisms of smoking-induced renal damage have been discussed, e.g. increase in blood pressure, alteration of intrarenal hemodynamics, as well as activation of the sympathetic nerve, the reninangiotensin and the endothelin systems. The pathomechanisms are, however, only partly understood. Once ESRF has become established, the failure to discontinue smoking adversely affects the prognosis of patients on renal replacement therapy, mainly by increasing the risk of cardiovascular complications. Discontinuation of smoking has been shown to improve both renal and cardiovascular prognosis in the renal patient and is probably the single most effective measure to retard progression of renal failure.
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Affiliation(s)
- S R Orth
- Division of Nephrology and Hypertension, Inselspital, University of Berne, Switzerland.
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13
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Cannata-Andía JB. Pathogenesis, prevention and management of low-bone turnover. Nephrol Dial Transplant 2001; 15 Suppl 5:15-7. [PMID: 11073269 DOI: 10.1093/ndt/15.suppl_5.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J B Cannata-Andía
- Instituto Reina Sofia de Investigación, Hospital Central de Asturias, Universidad de Oviedo, Spain
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14
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Cannata-Andía JB. Reconsidering the importance of long-term low-level aluminum exposure in renal failure patients. Semin Dial 2001; 14:5-7. [PMID: 11208028 DOI: 10.1046/j.1525-139x.2001.00002.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Aluminum toxicity is widely considered a problem of the past. However, low-level aluminum exposure and low but abnormal body burdens of aluminum are common. Aluminon, the routinely used histochemical stain for aluminum in bone, has a low sensitivity. The role of aluminum in renal osteodystrophy needs to be reassessed using more sensitive techniques. Low-level aluminum exposure also may resu in subtle neurological dysfunction, another area that needs further investigation.
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Fernández-Martín JL, Canteros A, Alles A, Massari P, Cannata-Andía J. Aluminum exposure in chronic renal failure in iberoamerica at the end of the 1990s: overview and perspectives. Am J Med Sci 2000; 320:96-9. [PMID: 10981483 DOI: 10.1097/00000441-200008000-00006] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Epidemic aluminum neurotoxicity has virtually disappeared in the dialysis population; however, sporadic toxic effects caused by contamination of water with aluminum are still reported. In this review, the current situation in Iberoamerica is analyzed. Exposure to aluminum through dialysate shows considerable geographical differences even within the same country, including seasonal variability. Sometimes the tap water showed very high aluminum content that does not permit the water treatment system to efficiently remove all the aluminum, forcing the use of water treatment systems with a double reverse-osmosis filter on line. The use of adequate water treatment systems and a correct control policy has improved the quality of the dialysate, minimizing the aluminum exposure. However, an additional problem in Iberoamerica is the difficulty to obtain aluminum-free concentrates for the preparation of the final dialysis solution. Aluminum still seems to be implicated in a great percentage of symptomatic low-bone remodeling lesions in South America compared with Europe, demonstrating that exposure to aluminum through dialysate is still a cause of concern in some areas of the world.
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Affiliation(s)
- J L Fernández-Martín
- Bone and Mineral Research Unit, Hospital Central de Asturias, Instituto Reina Sofía de Investigación, Oviedo, Spain
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16
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Jorgetti V, López BD, Caorsi H, Ferreira A, Palma A, Menendez P, Douthat W, Olaizola I, Ribeiro S, Jarava C, Moreira E, Cannata J. Different patterns of renal osteodystrophy in Iberoamerica. Am J Med Sci 2000; 320:76-80. [PMID: 10981479 DOI: 10.1097/00000441-200008000-00002] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The various forms of renal osteodystrophy are predominant hyperparathyroid bone disease, mixed uremic osteodystrophy, low turnover osteomalacia, and adynamic bone disease. The present study analyses a total number of 1,209 bone biopsies from 5 different countries (Brazil, Uruguay, Argentina, Portugal, and Spain). Low turnover osteomalacia and mixed uremic osteodystrophy were more common in Brazil, Uruguay, and Argentina than in Portugal and Spain whereas predominant hyperparathyroid bone disease was seen more often in Portugal and Spain. In all centers, independent of the aluminum staining technique used, the extent of aluminum deposited in bone was greater in patients presenting with low bone turnover, whether from low turnover osteomalacia or adynamic bone disease, than in the predominant hyperparathyroid bone disease. In summary, even though recent reports have indicated that, over the last decade, the incidence of aluminum-induced toxicity was reduced, aluminum still seems to be implicated in a great percentage of symptomatic low bone remodelling lesions in Iberoamerica.
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Abstract
Renal osteodystrophy may present with a wide spectrum of bone lesions, ranging from high bone turnover to low bone turnover. Decreased serum calcium and 1,25-dihydroxy vitamin D synthesis and retention of phosphate are involved in the pathogenesis of high bone turnover. However, several factors may influence the evolution of this disorder. The use of different therapeutic approaches (such as calcium supplements, phosphate binders, vitamin D metabolites, etc.), the type of treatment (either hemodialysis or continuous ambulatory peritoneal dialysis), and also the changes in the type of patients to whom we are offering dialysis (more diabetics and older patients are currently included in dialysis programs) may have introduced changes modifying the form of presentation of the bone metabolic disorders. As a result, recent studies reported a greater prevalence of adynamic forms of renal osteodystrophy. Patients with adynamic bone (with or without aluminum) would have more difficulties in handling and buffering calcium loads; consequently, they would have a higher risk of extraosseous calcifications.
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Affiliation(s)
- J B Cannata Andía
- Bone and Mineral Research Unit, Instituto Reina Sofia de Investigación, Hospital Central de Asturias, Universidad de Oviedo, Spain.
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18
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Affiliation(s)
- J B Cannata-Andía
- Instituto Reina Sofía de Investigation, Hospital Central de Asturias, Universidad de Oviedo, Spain
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