[Glomerulonephritis and organic solvents].
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Biomedical subjects
Publications and source records attributed to U Ravnskov.
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Seventy-one patients with nonsystemic, nonacute glomerulonephritis were included in a follow-up study on the influence of hydrocarbon exposure on the course of their disease. A possible exposure was ruled out by interview performed by occupational hygienists unaware of the outcome of the disease. The patients were allocated to three groups according to their hydrocarbon exposure. One group consisted of patients who had never been exposed; the second of patients who were exposed during follow-up and the third of patients who had discontinued their previous exposure. Each group was subdivided into one group with a glomerular filtration rate (GFR) that remained normal, and one group with a GFR that was, or became, subnormal. Patients with a subnormal GFR who discontinued their exposure had a more favorable course than those who continued to be exposed in spite of an initially lower mean GFR and an initially higher frequency of hypertension. No significant difference was seen between the groups with a normal GFR.
Many hydrocarbons have properties which make them candidates for causing glomerulonephritis. They alter most immune functions and create a state of immunity deficiency; they damage the tubules which may lead to interstitial fibrosis and increased postglomerular capillary resistance furthering the trapping of macromolecules in the glomeruli; and they probably increase tissue permeability to macromolecules. The idea that hydrocarbons cause glomerulonephritis is supported by findings of an association between glomerulonephritis and hydrocarbon exposure, by findings of a relationship between tubulointerstitial damage and glomerular filtration rate in glomerulonephritis, and by findings of immunity deficiency in most subgroups of glomerulonephritis.
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The occupations, as given in the national public census 1975, of 124 adult patients with non-systemic glomerulonephritis were compared with those of the general population in the catchment area of the hospital. Occupations assumed to be linked with exposure to organic solvents or fuels were commoner among patients than in the general population. The finding supports the idea that such exposure is causal in glomerulonephritis.
The excretion of N-acetyl-beta-glucosaminidase (Nag) was studied in 109 patients with glomerulonephritis. A positive correlation was found between the concentration of albumin and Nag in the urine. Almost all the urinary Nag had the properties of the tissues, not of the serum isoenzyme. The ratio between Nag and albumin in the urine was significantly lower in patients with minimal lesions and in those with focal sclerosis than in those with proliferative, membrano-proliferative and membranous glomerulonephritis. The excretion of Nag per g creatinine differed significantly between the various histologic subgroups of glomerulonephritis but not between groups with various degrees of tubulointerstitial changes. The excretion of Nag in 9 patients with proximal tubular damage induced by exposure to cadmium in the past was only moderate. We suggest that urinary Nag excretion is not caused by an increased glomerular permeability to macromolecules but may instead reflect the activity of renal disease.
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Fifty patients with biopsy-proven glomerulonephritis and 100 sex- and age-matched controls (50 patients each with non-glomerular renal disease or acute appendicitis) were asked by questionnaire and a telephone interview whether they had been exposed to organic solvents. The questioning and the evaluation of the exposure, if any, was made without knowing the diagnosis of the interviewee. Fifty per cent of the patients with glomerulonephritis reported more than slight exposure, but only 20% of the controls. Exposure to organic solvents may often play a role in the causation of glomerulonephritis.
A man and his daughter had acute glomerulonephritis, the daughter eight years after the father. Both were exposed to vapours of organic solvents shortly before the onset of nephritis.
Nine pigs were fed crystalline ochratoxin A in their feed at a concentration of about 1 mg/kg. Three pigs and their controls were killed after 3 months and 6 pigs and controls were killed after 2 years. A decrease of the ratio TmPAH/CIn, increased urinary glucose excretion and decreased ability to concentrate urine, occurred within a few weeks and aggravated slightly during the 2-year period. Changes in renal structure, characterized by degeneration and atrophy of proximal tubules, interstitial fibrosis and hyalinization of glomeruli, were progressive during time of exposure, but terminal renal failure was not reached. The kidney, liver, muscular and adipose tissue contained 3 to 27 microgram ochratoxin A/kg after 3 months of exposure. No further accumulation of ochratoxin A residue was found after 2 years of exposure.
Fifteen patients with evidence of acute poststreptococcal glomerulonephritis were asked about their contact with vapours of organic solvents. Six patients reported brief exposure shortly before the onset of glomerulonephritis, 4 fairly long exposure, and 5 none or insignificant. At the latest followup, 3 of 4 patients who were still exposed to such solvents had proteinuria and a low glomerular filtration rate (GFR), and 2 were hypertensive. Of the 11 patients who had never been or were no longer exposed, the GFR was insignificantly decreased in 2, none had proteinuria and none were hypertensive. Fifteen age-and sex-matched controls, who had been infected with group A beta-hemolytic streptococci, T type 12, had not been exposed, or the exposure was insignificant and not related to the streptococcal infection. Exposure to organic solvents or other nephrotoxic agents may be the condition which determines the outcome of an infection with nephritogenic streptococci.
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Nine patients with various types of severe glomerulonephritis were treated with drainage of the thoracic duct (n=8) and/or plasmapheresis (n=6) without the use of pharmacological immunosuppression. In most of the patients treatment produced a prompt temporary regression of albuminuria and creatininemia. In one patient renal function was substantially improved 8 months after the last period of treatment, in 2 patients the progress of the uremia was probably retarded. In the remaining 6 patients treatment had no obvious effect on the course of the illness. Drainage of the thoracic duct and plasmapheresis may be of benefit in the treatment of glomerulonephritis, but their proper utilization requires further studies.
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