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Willhite CC, Ball GL, McLellan CJ. Total allowable concentrations of monomeric inorganic aluminum and hydrated aluminum silicates in drinking water. Crit Rev Toxicol 2012; 42:358-442. [DOI: 10.3109/10408444.2012.674101] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Rawy SM, Morsy GM, Elshibani MM. Lethality, accumulation and toxicokinetics of aluminum in some tissues of male albino rats. Toxicol Ind Health 2012; 29:254-63. [DOI: 10.1177/0748233711432576] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the present work, the lethality percentiles including median lethal doses (LD50), accumulation, distribution and toxicokinetics of aluminum in the liver, kidney, intestine, brain and serum of male albino rats, following a single oral administration were studied throughout 1, 3, 7, 14 and 28 days. The estimated LD50 at 24 h was 3.45 g Al/kg body weight (b.wt.). The utilized dose of Al was 1/50 LD50 (0.07 g Al/kg b.wt.). Aluminum residues, in Al-treated rats, were significantly decreased in response to the experimental periods and were negatively correlated with time. In addition, the hepatic, renal, intestinal, brain and serum Al contents were significantly higher than the corresponding controls at all experimental periods, except the brain that showed significant depletion when compared with its corresponding control after 28 days. Kinetically, the highest average of Al area under concentration − time curves (AUCtotal, μg/g day) and area under moment concentration − time curves (AUMCtotal, µg/g day2) recorded in the brain followed by kidney, serum, intestine and liver. The longest elimination half-life time ( t1/2, day) and the mean residence time (MRT, day) were recorded in the brain followed by the liver, kidney, serum and intestine. On the other hand, the slowest clearance rates (Cls, L/day) of Al, in order, were recorded in brain, kidney, serum, intestine and the liver. The elimination rate constant ( Lz, day−1) of Al from the brain was less than that in the intestine and serum was less than that in the liver and kidney. The computed maximum concentrations ( Cmax) of Al in the intestine > kidney > serum > brain > liver were recorded after 3, 3.8, 2.2, 5.4 and 3.8 days, respectively. The computed starting concentration ( C0, μg) of Al in serum was higher than its level in the intestine followed by the brain, kidney and liver.
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Affiliation(s)
- Sayed M Rawy
- Faculty of Sciences and Arts, Khulais, King Abdul-Aziz University, Saudi Arabia
| | - Gamal M Morsy
- Department of Zoology, Faculty of Science, Cairo University, Egypt
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Goodwin CM, Hoffman JA. Deep Vein Thrombosis and Stress Ulcer Prophylaxis in the Intensive Care Unit. J Pharm Pract 2011; 24:78-88. [DOI: 10.1177/0897190010393851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Deep vein thrombosis (DVT) and stress gastric ulcers can be serious complications in patients admitted to the intensive care unit. This review discusses the risk factors associated with the development of DVT and stress-related mucosal disease (SRMD), evaluates the available literature on current options for DVT and stress ulcer prophylaxis, and examines the associated adverse effects and optimal duration of therapy.
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Affiliation(s)
- Corey M. Goodwin
- Department of Pharmacy, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
| | - Jason A. Hoffman
- Department of Pharmacy, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
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Hamano Nagaoka M, Maitani T. Speciation of Aluminium in Human Serum Investigated by HPLC/High Resolution Inductively Coupled Plasma Mass Spectrometry (HR-ICP-MS): Effects of Sialic Acid Residues of the Carbohydrate Chain on the Binding Affinity of Aluminium for Transferrin. ACTA ACUST UNITED AC 2009. [DOI: 10.1248/jhs.55.161] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Tamio Maitani
- National Institute of Health Sciences
- University of Shizuoka
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Nagaoka MH, Maitani T. Binding affinity of aluminium to human serum transferrin and effects of carbohydrate chain modification as studied by HPLC/high-resolution ICP-MS--speciation of aluminium in human serum. J Inorg Biochem 2006; 99:1887-94. [PMID: 16139893 DOI: 10.1016/j.jinorgbio.2005.06.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Revised: 06/21/2005] [Accepted: 06/27/2005] [Indexed: 11/28/2022]
Abstract
Aluminium (Al) in the blood is bound to transferrin (Tf), a glycoprotein of about 80kDa that is characterized by its need for a synergistic anion. In this focused review, the binding affinity of Al to Tf is surveyed in the context of our recent studies using on-line high-performance liquid chromatography/high-resolution inductively coupled plasma mass spectrometry (HPLC/HR-ICP-MS). Al in human serum without any in vitro Al-spikes was present in a form bound to the N-lobe site of Tf. The influences of sialic acid in the carbohydrate chain of human serum Tf (hTf) were studied using asialo-hTf, obtained by treatment with sialidase. The binding affinity of Fe was similar between asialo-hTf and native-hTf, while that of Al for asialo-hTf was larger than that for native-hTf, especially in the presence of oxalate, a synergistic anion. The above findings are discussed in relation to diseases in which the serum concentrations of carbohydrate-deficient Tf and oxalate are augmented.
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Affiliation(s)
- Megumi Hamano Nagaoka
- National Institute of Health Sciences, Kamiyoga 1-18-1, Setagaya, Tokyo 158-8501, Japan.
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7
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Abstract
Aluminium (Al) is absorbed from a variety of foodstuffs and medications. Its major route of elimination from the body is in the urine. However, current knowledge concerning its glomerular filtration and, more particularly, its reabsorption/secretion is fragmentary. Most (80-90%) of Al in the plasma is normally bound to protein (mainly transferrin) and is therefore unfilterable; the remainder is bound to low molecular mass compounds, of which citrate appears to be the most important. In vitro determinations using artificial membranes indicate that approximately 10% of Al is filtered at normal plasma concentrations. However, when plasma Al is raised experimentally, its filterability falls, unless the excess Al is complexed with citrate; the aluminium citrate complex appears to be freely filtered. Information on tubular Al reabsorption at normal plasma concentrations is inconsistent. Filtered Al appears to be at least partially reabsorbed, although the reabsorptive mechanisms remain speculative. A consensus is emerging that elevated plasma Al concentrations result in a fall in fractional Al reabsorption, and a recent micropuncture study indicates that under these circumstances the only significant site of Al reabsorption is the loop of Henle.
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Affiliation(s)
- D G Shirley
- Department of Physiology, Centre for Nephrology, University College London, London, UK.
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Hiramoto JS, Terdiman JP, Norton JA. Evidence-based analysis: postoperative gastric bleeding: etiology and prevention. Surg Oncol 2003; 12:9-19. [PMID: 12689666 DOI: 10.1016/s0960-7404(02)00073-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although the incidence of stomach hemorrhage is declining, stress-related gastric bleeding remains an important source of morbidity and mortality in cancer patients undergoing major surgical procedures to remove tumor. Prevention of stress-related bleeding is desirable; however, the optimal use of drugs to prevent gastric bleeding is unclear. Prophylaxis is recommended for surgical patients who require prolonged mechanical ventilation or have a coaguloathy. Histamine-2 receptor antagonists and sucralfate will reduce the likelihood of clinically important gastric-bleeding. Sucralfate appears to be less effective than H-2 blockers, but it is associated with fewer side effects such as nosocomial pneumonia. Preliminary studies show that proton pump inhibitors are most effective, have few side effects, but are most expensive. Intravenous proton pump inhibitors may be the drugs of choice for stress ulcer prophylaxis (SUP) in high-risk patients.
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Affiliation(s)
- Jade S Hiramoto
- Department of Surgery, University of California, 533 Parnassus Ave Room U-372, San Francisco, CA 94143-7088, USA
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Thorburn K, Samuel M, Smith EA, Baines P. Aluminum accumulation in critically ill children on sucralfate therapy. Pediatr Crit Care Med 2001; 2:247-249. [PMID: 12793950 DOI: 10.1097/00130478-200107000-00011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: Sucralfate, used in stress ulcer prophylaxis, contains aluminum, which can be absorbed from the gut. OBJECTIVE: To determine whether toxic serum aluminum levels can develop after short-term sucralfate therapy in critically ill children. DESIGN: Retrospective clinical study. SETTING: Pediatric intensive care unit of a pediatric university hospital. PATIENTS: Nineteen patients receiving mechanical ventilatory support (median age, 5 yrs [range, 0.25-16 yrs]; median weight, 17 kg [range, 3.5-60 kg]). INTERVENTIONS: All patients received sucralfate suspension nasogastrically. Measurements and RESULTS: Serum aluminum concentrations were measured after a short period on sucralfate therapy (median time, 7 days [range, 3-14 days]). There was no correlation between total sucralfate dose received (p =.35) or dose of sucralfate per unit of body weight (p =.55) and serum aluminum. Nine patients received peritoneal dialysis. Serum aluminum levels were higher in the nine patients who received peritoneal dialysis (median aluminum concentration, 2.86 &mgr;mol/L [range, 0.19-12.3 &mgr;mol/L]) than the ten patients not dialyzed (median aluminum concentration, 0.55 &mgr;mol/L [range, 0.18-0.94 &mgr;mol/L]) (p =.001). The peak serum creatinine levels were higher in the dialyzed patients (median creatinine level, 500 &mgr;mol/L [range, 163-910 &mgr;mol/L]) than those not dialyzed (median creatinine level, 98 &mgr;mol/L [range, 36-415 &mgr;mol/L]) (p =.006). There was a trend toward correlation between peak serum creatinine and serum aluminum (p =.06). CONCLUSION: Aluminum accumulation occurs in children with acute renal failure on sucralfate, especially those receiving dialysis. If sucralfate is used in children in renal failure, serum aluminum concentrations should be monitored regularly.
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Affiliation(s)
- Kentigern Thorburn
- Departments of Paediatric Intensive Care (Drs. Thorburn, Samuel, and Baines) and the Department of Biochemistry (Ms. Smith), Alder Hey Children's Hospital, Liverpool, UK
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Abstract
OBJECTIVE To assess the potential for the development of aluminum toxicity in patients with renal insufficiency or chronic renal failure who are taking sucralfate. DATA SOURCES Clinical literature accessed through MEDLINE (1966-December 1999) and International Pharmaceutical Abstracts (1970-December 1999). Key search terms included sucralfate, renal failure, renal insufficiency, and end-stage renal disease. DATA SYNTHESIS Urinary excretion is an important route of elimination for systemically absorbed aluminum. Accumulation of aluminum in patients with impaired renal function may lead to significant toxicity. A potential source of aluminum is the antiulcer medication sucralfate. Studies and case reports evaluating the use and toxicity of sucralfate in patients with normal renal function, as well as those with renal failure or renal insufficiency, were reviewed. CONCLUSIONS Aluminum accumulation and toxicity have been reported with the use of sucralfate in patients with compromised renal function. The risk of toxicity most likely represents a long-term complication of sucralfate use in this patient population. Toxicity may be enhanced by concurrent use of other aluminum-containing medications, such as phosphate binders or antidiarrheal preparations. These medications, in addition to sucralfate, should be avoided if possible in patients with end-stage renal disease. Patients with renal failure or renal insufficiency who are undergoing prolonged sucralfate therapy should be monitored for potential signs of aluminum toxicity.
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Affiliation(s)
- B A Hemstreet
- School of Pharmacy, University of Colorado Health Sciences Center, Denver 80262-0238, USA.
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Mulla H, Peek G, Upton D, Lin E, Loubani M. Plasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration: a randomized, controlled trial. Crit Care Med 2001; 29:267-71. [PMID: 11246304 DOI: 10.1097/00003246-200102000-00008] [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: 11/26/2022]
Abstract
OBJECTIVE To investigate plasma aluminum levels in critically ill patients requiring continuous venovenous hemofiltration (CVVH), while receiving sucralfate for stress ulcer prophylaxis. DESIGN Randomized, controlled study. SETTING Cardiothoracic intensive care unit. PATIENTS Twenty postoperative cardiac surgical patients INTERVENTIONS Twenty patients requiring CVVH support for acute renal failure were randomized into two groups for concurrent stress ulcer prophylaxis. Group 1 (n = 10) received nasogastric sucralfate, and group 2 patients received intravenous ranitidine. Plasma aluminum samples were analyzed at baseline and on days 1, 4, 8, and 14. MEASUREMENTS AND MAIN RESULTS In both the sucralfate and ranitidine groups, clinical characteristics, number of days the patients were on CVVH support (median, 5.5 [range, 2-32] days, and median, 3 [range, 2-18] days, respectively) and duration of prophylaxis (median, 12 [range, 4-42] days, and median, 16 [range, 3-62] days, respectively) were similar. There were no significant differences in the baseline aluminum concentrations (median, 0.37 [range, 0.15-1.63] micromol/L, vs. median, 0.32 [range, 0.11-1.0] micromol/L; p =.79). On initiation of therapy, aluminum levels in the sucralfate group increased dramatically on day 1 (median, 0.87 [range, 0.26-4.4] micromol/L) and peaked on day 4 (median, 2.84 [range, 1.52-4.44] micromol/L) with seven of the ten patients exhibiting levels of >2 micromol/L. In the ranitidine group, there were no significant elevations in aluminum levels above baseline. Analysis of the two groups at the four time points revealed that aluminum levels in the sucralfate group were up to 14 times higher, with the confidence intervals suggesting that the true value may be 2-27 times higher (p <.0001). On cessation of CVVH, a rapid decline in aluminum levels was observed. No clinical manifestations of these potentially toxic levels were observed. CONCLUSIONS The use of sucralfate for stress ulcer prophylaxis in patients requiring CVVH results in toxic elevations in plasma aluminum levels. Alternative agents should be considered for prophylaxis in these patients.
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Affiliation(s)
- H Mulla
- De Montfort University Centre for Pharmacy Practice Research, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
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Lin JL, Yang YJ, Yang SS, Leu ML. Aluminum utensils contribute to aluminum accumulation in patients with renal disease. Am J Kidney Dis 1997; 30:653-8. [PMID: 9370180 DOI: 10.1016/s0272-6386(97)90489-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Presently, aluminum utensils are widely used in the world, especially in the developing countries. However, whether aluminum leaching from such utensils contributes to aluminum accumulation or causes any damage in patients with renal disease remains unknown. We designed a prospective study to evaluate this problem. After excluding patients who were not examined at follow-up or who poorly complied during the study period, the opened randomized study consisted of 42 patients with chronic renal insufficiency (creatinine clearance <60 mL/min and >10 mL/min). All patients had not taken any aluminum-containing agents for 3 months, but used aluminum kitchen utensils for more than 1 year. Twelve patients comprised the control group; the other 30 patients comprised the study group. The aluminum kitchen utensils used by the study group patients were replaced with stainless steel utensils for 3 months, but those used by the control group were not. After 3 months, the decrements of serum aluminum (5.5 +/- 4.6 microg/L v 2.1 +/- 3.5 microg/L; P = 0.012) and daily urine aluminum excretion (14.3 +/- 15.2 microg/d v 2.1 +/- 5.6 microg/d; P = 0.005) in the study group patients were greater than those in the control group patients. The increments of transferrin saturation of the study group patients (1.8% +/- 9.5% v -3.7% +/- 9.5%; P = 0.052) were greater than those of the control group patients. In addition, the increments of iron (r = 0.368, P = 0.035) and transferrin saturation (r = 0.345, P = 0.049) positively correlated with the decrements of daily aluminum excretion in all patients. The study group patients with greater decrements of serum aluminum (>5.5 microg/L) had greater serum iron levels (90.2 +/- 27.7 microg/dL v 71.9 +/- 27.8 microg/dL; P = 0.047) and transferrin saturation (30.5% +/- 11.0% v 23.0% +/- 9.5%; P = 0.046) than those with less decrements of serum aluminum (<5.5 microg/L) after the study. Our study demonstrates that aluminum kitchen utensils may be the important aluminum exposure source for patients with chronic renal insufficiency who are not taking aluminum-containing agents, and hints that the long-term exposure of aluminum leaching from aluminum utensils probably affects iron levels in patients with chronic renal insufficiency. Further studies are clearly needed to confirm this observation.
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Affiliation(s)
- J L Lin
- Division of Nephrology, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, ROC
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Guillard O, Pineau A, Fauconneau B, Chobaut JC, Desaulty A, Angot A, Le Borgne E, Furon O. Biological levels of aluminium after use of aluminium-containing bone cement in post-otoneurosurgery. J Trace Elem Med Biol 1997; 11:53-6. [PMID: 9176873 DOI: 10.1016/s0946-672x(97)80011-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Use aluminium-containing biomaterials in otoneurosurgery for reconstitution of bone in contact with cerebrospinal fluid (CSF) also led to cases of encephalopathy and death. We report aluminium (Al) concentrations in the biological fluids of six French patients following use of Al-containing bone cement in otoneurosurgery. In five patients, the mean plasma Al levels (microgram/L) were: 1.20 +/- 0.05 (case 2), 9.20 +/- 0.10 (case 3), 1.00 +/- 0.05 (case 4), 2.80 +/- 0.05 (case 5) and 2.00 +/- 0.05 (case 6). In case 1, Al concentrations were 176 micrograms/L in the postauricular CSF accumulation, 34 micrograms/L in the pontocerebellar angle and 4 and 6 micrograms/L in the lumbar shunt. As a precautionary measure, in the first three cases the biomaterial was removed soon after the intervention, and no increase in plasma or CSF Al was observed. In the other cases, absence of neurobiological symptoms and normal concentrations of Al in plasma led neurosurgeons not to extract this biomaterial. Al assay thus may be considered to be a complementary and at times a decision-generating factor. Care is needed at all stages from sampling through analysis because Al is ubiquitous and factually high results may be clinically misleading. Herein, such considerations are discussed in conjunction with the neurotoxicity of this metal in man. In addition, the authors call for in-depth preliminary trials of these biomaterials in animals prior to introduction on the market.
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Affiliation(s)
- O Guillard
- Laboratory of Biochemistry and Toxicology, Jean Bernard Hospital, Poitiers, France
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Guillard O, Huguet F, Fauconneau B, Piriou A, Pineau A. Absence of gastrointestinal absorption or urinary excretion of aluminium from an allantoinate complex contained in two antacid formulations in patients with normal renal function. EUROPEAN JOURNAL OF CLINICAL CHEMISTRY AND CLINICAL BIOCHEMISTRY : JOURNAL OF THE FORUM OF EUROPEAN CLINICAL CHEMISTRY SOCIETIES 1996; 34:609-12. [PMID: 8877335 DOI: 10.1515/cclm.1996.34.8.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We studied the plasma and urinary excretion levels of aluminum (Al) on day 0, 10 and 30 in 79 patients with gastrointestinal symptoms and normal renal function who were receiving a complex based on Al allantoinates [C4H5N4 O3 Al (OH)2] and [C4H5N4 O3 Cl Al2 (OH)4]. We evaluated the extent of Al absorption after repeated administration of this complex in two antacid formulations, Ulfon Lyoc in lyophilised tablet form (group 1; n = 40) and Ulfon suspension (group 2; n = 39). The total Al load for each antacid and patient was 512 mg daily for a total of 15360 mg during the 30-day treatment. No significant rise in plasma Al concentration was noted with either formulation between day 0 and 10, day 0 and 30 or day 10 and 30, nor was there any significant increase in urinary excretion levels. Al absorption was not increased and no toxic effects were noted, indicating that such formulations are suitable for long-term therapy in patients with gastrointestinal symptoms.
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Affiliation(s)
- O Guillard
- Centre d'Etude et de Recherche sur les Xénobiotiques, Laboratoire de Biochimie et de Toxicologie, Hôpital Jean Bernard, Poitiers, France
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Greger JL, Radzanowski GM. Tissue aluminium distribution in growing, mature and ageing rats: relationship to changes in gut, kidney and bone metabolism. Food Chem Toxicol 1995; 33:867-75. [PMID: 7590531 DOI: 10.1016/0278-6915(95)00059-b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to determine whether accumulation and turnover of aluminium differed among growing (2 month old), mature (8 month old) and ageing (19 month old) rats and assess whether these differences could be ascribed to physiological changes with age. One day after a large oral dose (0.8 mmol Al in 0.75 M citrate) growing rats had the highest concentrations of aluminium in tibias, whereas ageing rats had the highest concentrations of aluminium in kidneys. The half-life of aluminium in tibias (38 v. 58 v. 173 days in growing, mature and ageing rats, respectively) and kidneys (9 v. 12 v. 16 days) lengthened with age. According to stepwise multiple regression analysis, 73% variation in tibia aluminium concentrations was explained by final body weight of rats, length of time after dosing, tibia weights, haematocrits, urinary hydroxyproline excretion, ulna calcium concentrations, and urinary creatinine excretion but 57% variation in kidney aluminium concentrations was explained by length of time after dosing and feed intake. Although age, per se, was a significant predictor of spleen and liver aluminium concentrations, the measured changes in gut, kidney, bone and mineral metabolism were less predictive of aluminium concentrations in livers and spleens than in bone.
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Affiliation(s)
- J L Greger
- Department of Nutritional Sciences, University of Wisconsin, Madison 53706, USA
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McCarthy JT, Dayton JM, Fitzpatrick LA, Gamble GL, Gonyea JE, Jenson BM, McLeod RA. The importance of bone biopsy in managing renal osteodystrophy. ADVANCES IN RENAL REPLACEMENT THERAPY 1995; 2:148-59. [PMID: 7614346 DOI: 10.1016/s1073-4449(12)80085-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A case is presented in which bone biopsy results helped to resolve not only difficult issues in the clinical management of the patient's renal osteodystrophy but also disruptive psychosocial problems surrounding her clinical course. The outcome was a satisfactory resolution based on rational medical treatment and directed supportive care. The presentation highlights important principles in the procurement, processing, and interpretation of the bone biopsy, while also addressing the importance of accurate diagnosis in facilitating the overall long-term management by the entire renal team.
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Affiliation(s)
- J T McCarthy
- Department of Social Services, Mayo Clinic, Rochester, MN 55905, USA
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Conway EL, O'Callaghan C, Drummer OH, Howes LG, Louis WJ. A single-dose comparison of the bioavailability of aluminium from two formulations of sucralphate in normal volunteers. Biopharm Drug Dispos 1994; 15:253-61. [PMID: 7880985 DOI: 10.1002/bdd.2510150307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The oral bioavailability of aluminium was compared after administration of 1 g sucralphate as either a tablet or a suspension (1 g/5 ml) in a crossover study in 16 healthy volunteers. Aluminium levels were detectable in all subjects pre-dose (21.4 +/- 8.8 micrograms l-1 before tablet; 21.4 +/- 7.4 micrograms l-1 before suspension) and there was a measurable increase in the plasma concentrations of aluminium in all subjects after administration of the suspension, and in 14 of the subjects after administration of the tablet formulation, with Cmax reached within the first 8 h in most subjects. Plasma levels were still elevated 72 h after dosing. The variability in plasma levels of aluminium was significantly higher after administration of the suspension (CV 39-53%) than after administration of the tablet (CV 29-44%), reflecting greater absorption of aluminium from the suspension formulation in three subjects. Similarly, the variance of the Cmax, AUC(0-72 h), and AUC(0-infinity) (for both the raw data and the baseline adjusted data) were all higher for the suspension than for the tablet. A point estimate of the difference of the pharmacokinetic parameters (determined from the median of the arithmetic Walsh averages) indicated little or no difference in Cmax, Tmax, or AUC(0-infinity) in the two formulations. In summary, the performance of the suspension formulation of sucralphate is more variable than the tablet formulation in vivo and some patients may therefore have higher circulating levels of aluminium on therapy with the suspension formulation.
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Affiliation(s)
- E L Conway
- Department of Clinical Pharmacology & Therapeutics, Austin Hospital, Heidelberg, Victoria, Australia
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Abstract
Drugs used in the treatment of peptic ulcer disease may interact with the renal system in a variety of ways. Since many agents are eliminated by renal excretion, clearance of these agents may be reduced and half-life extended in the presence of renal insufficiency. The histamine H2-receptor antagonists may interfere with renal tubular excretion of creatinine and cationic drugs, resulting in elevated serum concentrations and reduced renal clearance. The prostaglandin E1 analogue misoprostol is used as a cytoprotective agent but has renal effects. The renal effects differ between systems studied. In the rat, misoprostol reduces cyclosporin-induced renal tubular toxicity, whereas in humans it has been shown to attenuate renal allograft rejection. Sucralfate is the aluminium salt of sucrose octasulfate. It permits the absorption of aluminium in amounts similar to aluminium-containing antacids, and toxicity has been demonstrated in the presence of renal insufficiency. Bismuth compounds are used increasingly to treat peptic ulcer disease, and bismuth toxicity has been described in association with renal insufficiency. Aluminium-, calcium- and magnesium-containing antacids are used as oral phosphate binders in patients with renal insufficiency in addition to their usual indications. Cation absorption and accumulation with all of these antacid preparations has been described and may lead to toxicity.
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Affiliation(s)
- E Burgess
- Department of Medicine, University of Calgary, Alberta, Canada
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