Silicosis and chronic renal disease

Risk of Chronic Kidney Disease in Pneumoconiosis: Results from a Retrospective Cohort Study (2008-2019)

Background: Pneumoconiosis has considerable comorbidities, most notably pulmonary and cardiovascular diseases. However, the relationship between pneumoconiosis and chronic kidney disease (CKD) is largely unknown. The present study aimed to use a retrospective cohort study design to further clarify the association between pneumoconiosis and subsequent CKD risk. Methods: This is a nationwide, population-based, retrospective cohort study that used data from Taiwan’s National Health Insurance Database. Between 2008 and 2018, 17,952 newly diagnosed patients were included in the pneumoconiosis cohort, while 71,808 individuals without pneumoconiosis were included in the comparison cohort, with a propensity score matching for age, gender, and date of pneumoconiosis diagnosis. The development of CKD was monitored until the end of 2019. The risk was assessed using Cox proportional hazard regression models. Results: After controlling for age, gender, and comorbidity, the overall incidence of CKD was 1.69-fold higher in the pneumoconiosis cohort than in the comparison cohort (19.71 vs. 11.76 per 1000 person-years, respectively, p < 0.001), with an adjusted hazard ratio of 1.83 (95% confidence interval: 1.73−1.93). Stratified analyses by age group, gender, and presence of comorbidity revealed that the adjusted hazard ratios of CKD associated with pneumoconiosis remained significant (8/9). Furthermore, pneumoconiosis and tri-high (hypertension, hyperglycemia, and hyperlipidemia) interact positively with CKD development (p < 0.001). Conclusion: Patients with pneumoconiosis had a significantly higher risk of developing CKD than those without. Pneumoconiosis combined with hypertension, hyperglycemia, or hyperlipidemia would increase the risk even further. More studies are required to understand the possible pathophysiological mechanisms.

Inhaled Silica Nanoparticles Causes Chronic Kidney Disease in Rats

INTRODUCTION

Silica nanoparticles (SiNPs) released during the burning of sugarcane have been postulated to have a role in chronic kidney disease of unknown etiology. We tested the hypothesis that pristine SiNPs of the size present in sugarcane might cause chronic kidney injury when administered through the lung in rats.

METHODS

We administered 200 nm or 300 nm amorphous SiNPs twice weekly (4 mg/dose) or vehicle by oropharyngeal aspiration for 13 weeks to rats followed by sacrifice after an additional 13 weeks (26 weeks total). Tissues were evaluated for presence of SiNPs and evidence of histologic injury.

RESULTS

Both sizes of SiNPs caused kidney damage, with early tubular injury and inflammation (at week 13) that continued to inflammation and chronic fibrosis at week 26 despite discontinuing the SiNP administration. Both sizes of SiNPs caused local inflammation in the lung and kidney and were detected in the serum and urine at week 13, and the 200 nm particles also localized to the kidney with no evidence of retention of the 300 nm particles. At week 26 there was some clearance of the 200 nm silica from the kidneys, and urinary levels of SiNPs were reduced but still significant in both the 200 and 300 nm exposed rats.

CONCLUSIONS

Inhaled SiNPs causes chronic kidney injury that progresses despite stopping the SiNP administration. These findings are consistent with the hypothesis that human exposure to amorphous silica nanoparticles found in burned sugarcane fields could have a participatory role in chronic kidney disease of unknown etiology.

Lung-kidney interactions and their role in chronic kidney disease-associated pulmonary diseases

Chronic illnesses rarely present in a vacuum, devoid of other complications, and chronic kidney disease is hardly an exception. Comorbidities associated with chronic kidney disease lead to faster disease progression, expedited dialysis dependency, and a higher mortality rate. Although chronic kidney disease is most commonly accompanied by cardiovascular diseases and diabetes, there is clear cross talk between the lungs and kidneys pH balance, phosphate metabolism, and immune system regulation. Our present understanding of the exact underlying mechanisms that contribute to chronic kidney disease-related pulmonary disease is poor. This review summarizes the current research on kidney-pulmonary interorgan cross talk in the context of chronic kidney disease, highlighting various acute and chronic pulmonary diseases that lead to further complications in patient care. Treatment options for patients presenting with chronic kidney disease and lung disease are explored by assessing activated molecular pathways and the body's compensatory response mechanisms following homeostatic imbalance. Understanding the link between the lungs and kidneys will potentially improve health outcomes for patients and guide healthcare professionals to better understand how and when to treat each of the pulmonary comorbidities that can present with chronic kidney disease.

Ac-SDKP Attenuates Activation of Lung Macrophages and Bone Osteoclasts in Rats Exposed to Silica by Inhibition of TLR4 and RANKL Signaling Pathways

Background

Silica-induced inflammatory activation is associated with silicosis and various non-respiratory conditions. The present study was designed to examine the anti-inflammatory effects of N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP) on lung macrophages and bone osteoclasts after silica inhalation in rats.

Methods

Wistar rats and NR8383 and RAW 264.7 cell lines were used in the present study. The receptor activator of nuclear factor kappa-B ligand (RANKL) and toll-like receptor 4 (TLR4) signaling pathways was measured in the lung tissue of rats or NR8383/RAW 264.7 cells exposed to silica. The microarchitecture of the trabecular bone in the tibia and femur was evaluated in silicotic rats. Furthermore, the roles of Ac-SDKP on silicotic rats, silica-treated NR8383/RAW 264.7 cells, and RANKL-induced osteoclast differentiation were studied.

Results

The data indicated that silica inhalation might activate the RANKL and TLR4 signaling pathways in lung macrophages, thus inducing the lung inflammatory and proteolytic phenotype of macrophages and osteoclasts in lung and bone. Ac-SDKP maintained the lung elastin level by inhibiting lung inflammation and macrophage activation via the RANKL and TLR4 signaling pathways. Ac-SDKP also attenuated the reduction in femoral bone mineral density in silicotic rats by inhibiting osteoclast differentiation via the RANKL signaling pathway.

Conclusion

Our findings support the hypothesis that inhalation of crystalline silica induces activation of lung macrophages and bone osteoclasts via the RANKL and TLR4 signaling pathways. Ac-SDKP has the potential to stabilize lung homeostasis and bone metabolism.

Predictive value of novel biomarkers for chronic kidney disease among workers occupationally exposed to silica

There is a pressing need to find reliable biomarkers for the early diagnosis of silica-induced nephropathy. Abundant genes are upregulated in damaged kidneys with subsequent protein products appearing in the urine. Liver-type fatty acid-binding protein (L-FABP) and kidney injury molecule-1 (KIM-1) are among the most promising. Our objective was to study the importance of L-FABP and KIM-1 genes and their urinary proteins in the early detection of silica-induced renal injury, as compared with other conventional biomarkers. A cross-sectional study was conducted among 90 pottery workers occupationally exposed to silica, as compared to 90 controls. A full history taking and complete clinical examination were performed. Levels of serum creatinine, liver enzymes, urinary silicon, KIM-1, and L-FABP gene expression and protein products were measured. Estimated glomerular filtration rate (eGFR) was calculated, and abdominal ultrasound was performed. The results showed that the silica-exposed group had a statistically significant increase in serum creatinine and urinary silica, as well as a significant decrease in eGFR. Additionally, a significant increase in KIM-1 and L-FABP gene expression, associated with a significant increase in their urinary protein, was found among the exposed group. A positive correlation between urinary silica level and L-FABP gene expression was also found. A receiver operating characteristic curve analysis for L-FABP and KIM-1 gene as predictors for silica-induced nephropathy showed that L-FABP gene and protein specificity were greater than the KIM-1 gene and protein. Taken together, these findings suggest that the L-FABP gene and its protein product may be used as early indicators for renal injury among silica exposed workers.

Silicosis: An Update and Guide for Clinicians

This overview provides an update on silicosis epidemiology with review of exposures and emerging trends in acute and accelerated silicosis in the twenty-first century. The silicosis epidemics in mining, denim sandblasting, and engineering stone industries are highlighted. Clinical presentations of silicosis and silica-related conditions such as autoimmune, kidney, and mycobacterial disease, as well as lung cancer, are discussed. Important aspects of the new OSHA 2017 Silica Standard are presented. This review also includes practical guidance for clinicians to address questions that may arise when evaluating silica-exposed patients and to the public health responses needed following a diagnosis of silica-related disease.

A Pilot Study to Assess Inhalation Exposures among Sugarcane Workers in Guatemala: Implications for Chronic Kidney Disease of Unknown Origin

Background: Sugarcane workers in Central America experience a heavy burden of chronic kidney disease of unknown origin. We conducted a pilot study among worker proxies in Guatemala to characterize exposures to particulate matter, silica, heavy metals, and glyphosate, as well as to examine potential nephrotoxic exposures. Methods: Air, soil, and ash samples were collected and analyzed using scanning electron microscopy, X-ray diffraction, inductively coupled plasma mass spectrometry, and an enzyme-linked immunosorbent assay. Results: The average mass concentration for particulate matter (PM)_2.5 and PM₁₀₀ exposures were 360 µg/m³ (range: 32 to 1500 µg/m³) and 555 µg/m³ (range: 229 to 1170 µg/m³), respectively. The elemental composition of particles was largely silicon. The amount of crystalline silica was below 5 μg, yet the percentage of total silica was ~17% by weight. Putatively, the silica was in the amorphous form. Concentrations of aluminum and calcium ranged from 2–7 μg/m³. Glyphosate was not detectable in analyzed air samples but was detectable at concentrations ranging from 81–165 ppb in soil samples. Conclusion: Sugarcane workers are exposed to high concentrations of particulate matter. Future studies should investigate the potential role of silica, heavy metals, and agrochemicals in the etiology of chronic kidney disease in this population.

Profiling long non-coding RNA changes in silica-induced pulmonary fibrosis in rat

Silicosis is a kind of chronic and incurable lung fibrotic disease with pathogenesis and molecular mechanisms largely unknown. Mounting evidence suggests that long non-coding RNAs (lncRNAs) are involved in the pathogenesis of silicosis. However, how many lncRNAs involved in the pulmonary fibrosis remains to be elucidated. In this study, Wistar rats were exposed to silicon dioxide by an improved tracheal intubation method. Rats in the control group were treated with normal saline solution. Results showed that 28 days after exposure, there were significant differences in body weight and lung coefficient of rats treated with silica compared with control rats. The formation of lung fibrosis in silica-induced rats was confirmed by histologic examination. We then investigated the lncRNAs expression changes in lung tissues of silica-exposed rats and compared that with the rats in the control group using microarray. The results indicated that silica exposure leads to altered expression profile in 682 lncRNAs (300 upregulated and 382 downregulated). Seventy-three ceRNA pairs were acquired by predicted analysis. Kyoto Encyclopedia of Genes and Genomes pathway and Gene Ontology analyses were used to predict the biological pathway and functional classification of lncRNAs. The results showed that silica exposure affected 13 lncRNAs pathways. The functional classification mainly involved in protein binding, cell shape and extracellular exosome. This study indicated that alteration of lncRNAs may play a role in silica-induced pulmonary fibrosis through regulation of expressions of functional genes in lungs of rat. Our results provide more insights into the mechanism of silicosis.

Silica - A trace geogenic element with emerging nephrotoxic potential

Silica is a trace-geogenic compound with limited-bioavailability. It inflicts health-perils like pulmonary-silicosis and chronic kidney disease (CKD), when available via anthropogenic-disturbances. Amidst silica-imposed pathologies, pulmonary toxicological-mechanisms are well-described, ignoring the renal-pathophysiological mechanisms. Hence, the present-study aimed to elucidate cellular-cum-molecular toxicological-mechanisms underlying silica-induced renal-pathology in-vitro. Various toxicity-assessments were used to study effects of silica on the physiological-functions of HK-cells (human-kidney proximal-tubular cells - the toxin's prime target) on chronic (1-7 days) sub-toxic (80 mg/L) and toxic (100-120 mg/L) dosing. Results depicted that silica triggered dose-cum-time dependent cytotoxicity/cell-death (MTT-assay) that significantly increased on long-term dosing with ≥100 mg/L silica; establishing the nephrotoxic-potential of this dose. Contrarily, insignificant cell-death on sub-toxic (80 mg/L) dosing was attributed to rapid intracellular toxin-clearance at lower-doses preventing toxic-effects. The proximal-tubular (HK-cells) cytotoxicity was found to be primarily mediated by silica-triggered incessant oxidative-stress (elevated ROS).·This enhanced ROS inflicted severe inflammation and subsequent fibrosis, evident from increased pro-inflammatory-cum-fibrogenic cytokines generation (IL-1β, IL-2, IL-6, TNF-α and TGF-β). Simultaneously, ROS induced persistent DNA-damage (Comet-assay) that stimulated G2/M arrest for p53-mediated damage-repair, aided by checkpoint-promoter (Chk1) activation and mitotic-inducers (i.e. Cdc-25, Cdk1, cyclinB1) inhibition. However, DNA-injuries surpassed the cellular-repair, which provoked the p53-gene to induce mitochondrial-mediated apoptotic cell-death via activation of Bax, cytochrome-c and caspase-cascade (9/3). This persistent apoptotic cell-death and simultaneous incessant inflammation culminated in the development of tubular-atrophy and fibrosis, the major pathological-manifestations of CKD. These findings provided novel-insights into the pathological-mechanisms (cellular and molecular) of silica-induced CKD, inflicted on chronic toxic-dosing (≥100 mg/L).Thereby, encouraging the development of therapeutic-strategies (e.g. anti-oxidant treatment) for specific molecular-targets (e.g. ROS) to retard silica-induced CKD-progression, for reduction in the global-CKD burden.

The Burden of Silicosis in Michigan: 1988-2016

RATIONALE

Exposure to respirable crystalline silica causes silicosis, a preventable, progressive occupational lung disease. A more rigorous occupational health standard for silica could help protect silica-exposed workers.

OBJECTIVES

To describe trends over 29 years of silicosis surveillance in Michigan.

METHODS

Michigan law requires the reporting of silicosis. We confirmed the diagnosis of silicosis in reported cases using medical questionnaires, review of medical records, and chest radiographs. The Michigan Occupational Safety and Health Administration (OSHA) conducted enforcement inspections at the workplaces of the silicosis cases, including air monitoring for silica and evaluation of workplace medical surveillance programs.

RESULTS

The Michigan surveillance program identified 1,048 silicosis cases from 1988 to 2016, which decreased from 620 during 1988-1997, to 292 during 1998-2007, to 136 during 2008-2016. The cumulative incidence rate of silicosis decreased from 3.7 to 1.4 to 0.7 cases per 100,000 men 40 years of age and older in Michigan over the same three periods. African Americans had a higher cumulative incidence rate of silicosis, with 6.0 cases per 100,000 African American men 40 years of age and older in Michigan compared with 1.2 cases per 100,000 white men 40 years of age and older in Michigan. The cases identified had severe disease; 59% had progressive massive fibrosis or category 2 or 3 small opacities per B-reading classification of the chest radiograph. Seventeen percent reported ever having active tuberculosis. On spirometry, 76% of ever smokers and 72% of never smokers demonstrated either a restrictive or an obstructive pattern. Most (65%) had not applied for workers' compensation benefits; the percentage who applied for benefits decreased from 42% to 28-16% over the three periods. Thirty-four of 55 (62%) workplace inspections found exposures above the new OSHA 50 μg/m3 respirable crystalline silica permissible exposure limit, and only 11% of inspected companies screened their workers for silicosis.

CONCLUSIONS

Adults with confirmed cases of silicosis have advanced disease and morbidity. Most are not using workers' compensation to pay for their care. The new OSHA silica standard, which lowers the permissible exposure limit for silica and requires medical monitoring to identify workers with silicosis, will help reduce the burden of silica exposure. It is critical for pulmonologists to be vigilant to recognize and manage this preventable occupational lung disease.

MiR-503 modulates epithelial-mesenchymal transition in silica-induced pulmonary fibrosis by targeting PI3K p85 and is sponged by lncRNA MALAT1

Silicosis is a kind of chronic, progressive and incurable lung fibrotic diseases with largely unknown and complex pathogenesis and molecular mechanisms. Mounting evidence suggests that microRNAs (miRNAs, miRs) are involved in the pathogenesis of silicosis. Our previous study based on miRNA microarray had shown that the expression levels of miR-503 were down-regulated in mouse lung tissues of silica-induced pulmonary fibrosis. Here, we validated the decreased expression of miR-503 in the fibrotic mouse lung tissues, human bronchial epithelial cells (HBE) and human lung adenocarcinoma A549 cells which were exposed to silica. In addition, overexpressed miR-503 inhibited silica-induced pulmonary fibrosis by attenuating the severity and the distribution of lesions in vivo and limiting the process of epithelial-mesenchymal transition (EMT) in vitro. Our molecular study further demonstrated that PI3K p85 is one of the target genes of miR-503 and the downstream molecules (Akt, mTOR and Snail) are tightly associated with EMT. Furthermore, the up-regulated lncRNA Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), acted as a competing endogenous RNA (ceRNA), can directly bound to miR-503, which indicated that lncRNA MALAT1 may modulate the expression of miR-503 thus triggering the activation of downstream fibrotic signaling pathways. Taken together, our data suggested that MALAT1-miR-503-PI3K/Akt/mTOR/Snail pathway plays critical roles in silica-induced pulmonary fibrosis.

Occupational exposure to respirable crystalline silica and chronic non-malignant renal disease: systematic review and meta-analysis

Background

While occupational exposure to respirable silica is known to lead to lung disease, most notably silicosis, its association with chronic kidney disease is unclear.

Objectives

This review explores the association between occupational exposure to respirable silica and chronic non-malignant renal disease such as glomerulonephritis. The evidence has been collected and compiled. Possible sources of bias are thoroughly discussed.

Methods

Cohort studies with silica exposure and case–control studies of renal disease were searched in PubMed until January 2015. Two authors independently abstracted data; any disagreement was resolved by consulting a third reviewer. A meta-analysis was performed to evaluate the association to silica exposure.

Results

A total of 23 cohort and four case–control studies were included in the analysis. The meta-analysis of cohort studies yielded elevated overall SMRs for renal disease. Some studies, however, included dose–response analyses, most of which did not show a positive trend. The approaches and results of the case–control studies were very heterogeneous.

Conclusions

While the studies of cohorts exposed to silica found elevated SMRs for renal disease, no clear evidence of a dose–response relationship emerged. The elevated risk may be attributed to diagnostic and methodological issues. In order to permit a reliable estimation of a possible causal link, exposed cohorts should be monitored for renal disease, as the information from mortality studies is hardly reliable in this field.

Electronic supplementary material

The online version of this article (doi:10.1007/s00420-017-1219-x) contains supplementary material, which is available to authorized users.