Anti-glomerular basement membrane antibody-mediated glomerulonephritis due to glue sniffing

Paint-thinner-induced Acute Kidney Injury: A Case Series and Review

Occupational health hazards contribute significantly to the morbidity and mortality of workers in factories. Toluene has become a widely abused inhaled volatile drug. The spectrum of toluene-induced renal injury includes rhabdomyolysis, myoglobinemia, distal renal tubular acidosis (RTA), acute tubular necrosis, glomerulonephritis, and interstitial nephritis. We describe two patients with paint-thinner-induced kidney injury who were affected through different routes of exposure and recovered well, with one requiring dialysis support; the second patient, who had developed Type 1 distal RTA and mild kidney injury, was managed with conservative measures. Toluene can cause acute neurological symptoms, accompanied by severe metabolic alterations, as well as organ injury and dysfunction. A common association of the development of hypokalemic paralysis and metabolic acidosis with toluene intoxication was observed. Liver injury and rhabdomyolysis are also common. Vomiting, dehydration, tubular injury, and rhabdomyolysis are all possible additional causes of acute renal failure in toluene intoxication. Type 1 distal RTA, which is characterized by an inability to lower urine pH despite acidemia, results in hyperchloremic metabolic acidosis with hypokalemia. The management of acute toluene toxicity is largely conservative, consisting of correcting the electrolytes and the acid-base balance, fluid alterations, and renal replacement therapy in severe acute kidney injury. A clinical suspicion of organ failure and prompt supportive care leads to encouraging results. Adequate protective steps for workplaces involved in the use of such substances in confined spaces include prior risk assessment, using low-toxicity chemical products, ensuring adequate ventilation, safety training, and using appropriate personal protective equipment.

Outcomes in patients with Goodpasture's syndrome and hydrocarbon exposure

Goodpasture's Syndrome has been associated with hydrocarbon exposure. No study has examined outcomes in these patients. All reported cases of Goodpasture's Syndrome and hydrocarbon exposure were identified using MEDLINE and was analyzed for factors related to outcomes. A total of 43 cases were identified since 1969. The mean age of patients was 28 years old. There was a slight predilection for males (60%) when analyzing gender. Various types of hydrocarbons were identified and the duration of exposure varied from minutes to years. A majority of patients (86%) had pulmonary hemorrhage and antiglomerular basement membrane antibodies (AGBM) (92%). Patients were treated with immunosuppressive agents. The only significant statistical correlation was female patients with hydrocarbon exposure were younger. There was no correlation between age, gender, duration of exposure, presence of pulmonary hemorrhage or AGBM, or other risk factors and outcome. The relationship between hydrocarbon exposure and Goodpasture's Syndrome remains unclear since only 6% of cases in the literature had exposure. Even though most patients survived, no factor studied affected outcome making it difficult to predict prognosis in these patients.

Occupational hydrocarbon exposure and chronic nephropathy

This review aims at discussing the questions raised by the hydrocarbon-related chronic nephropathy and its possible consequence, the hydrocarbon-related chronic renal failure. It has been attempted to adopt the point of view of the clinician. Therefore, the most important part of the review is devoted to a presentation and an analysis of the available data on humans. The main features of the available studies on human subjects are presented, their conclusions discussed in the light of the possible methodological flaws, and practical conclusions drawn. After a discussion of the main difficulties encountered for selecting the suitable exposure indicator, the studies are discussed in order of decreasing quality of the study design (cohort, case-control, cross-sectional studies, and the case reports). It is concluded that a great deal of controversies about chronic hydrocarbon-related nephropathy is explained by differences in the study design and that hydrocarbon-induced nephropathy is probably more than a mere hypothesis, although a causal relationship has not yet been proven. Finally, some practical consequences for dealing with a hydrocarbon-exposed patient diagnosed with a kidney disease and the need for further research are discussed.

The association between hydrocarbon exposure and anti-glomerular basement membrane antibody-mediated disease (Goodpasture's syndrome)

Despite numerous reports suggesting a relationship between hydrocarbon exposure and Goodpasture's syndrome, the nature of this association is still undefined. The present review was motivated by a patient with Goodpasture's syndrome who wondered if his illness was employment related. The patient had been working in an automobile servicing garage, where he was in frequent contact with a wide array of hydrocarbon solvents. Previous reports linking hydrocarbon exposure to Goodpasture's syndrome and anti-GBM antibody-mediated nephritis are analysed. A total of seventeen papers presenting 31 patient with hydrocarbon exposure and anti-GBM antibody-mediated disease are reviewed. The results suggest a causal relationship. Specific hydrocarbons implicated as potential toxins are listed, epidemiologic data are reviewed, and the association with cigarette smoking is discussed.