Tehran University Medical Journal

Background: The health risk associated with chronic exposure to organic solvents investigated in several epidemiologic studies indicates a significant relationship between solvent exposure and glomerulonephritis. Solvents are the most commonly used chemicals in industry. According to European statistics 43% of all solvent consumption takes place in the painting industry, 10% in metal cleansing, 6.7% in adhesives and 3.9 percent in the laundry (dry cleaning) industries. Although BUN and creatinine indicate massive loss of glomerular function, microalbumin is a sensitive urinary marker for nephrotoxins in the early detection of solvent-induced effects on the glomerulus. The purpose of our study was to use microalbumin, serum BUN and serum creatinine levels to identify occupational solvent-induced effects on the glomerulus.
Methods: Renal dysfunction was monitored by microalbumin, BUN and creatinine serum levels in a cohort study of 92 workers currently exposed to solvents (solvent group). A control group of 92 individuals were selected from parts of the same factory not exposed to solvents. All individuals in the study were men, without diabetes or hypertension. The percentage of smokers was equal between the two groups. The solvent group was selected using environmental monitoring of organic solvents in different parts of the painting room. The individuals were chosen by simple random selection. Exclusion factors included less than one year of work in the painting room, use analgesic or aminoglycoside one month before the study and medically diagnosed renal disease, such as glomerulonephritis or renal failure. Data was gathered using a questionnaire requesting demographic information, history of present and past diseases, present and past occupational history, drug history, history of illness in their colleagues and safety conditions at work (use of safety gloves, masks, clothing, goggles and general and local ventilation). The results analyzed with SPSS 11.5.
Results: Several studies showed that solvents cause renal disorder (tubular and glomerular), although glomerulonephritis is more prevalent. The mean age of the solvent group was 28.6 ±2.7 years and was 33.7 ±7 years in control group (p<0.05). The mean duration of solvent exposure was 4.8 ±1.5 years. Statistically meaningful differences were found between solvent and control groups for microalbuminuria, increased serum BUN and creatinine levels (p<0.05), although there was no significant correlation between these parameters and the duration of exposure (p>0.05).
Conclusion: The results suggest that kidney dysfunction results from chronic occupational exposure to solvents at levels found in automobile painting rooms in Iran. We recommend increased monitoring of workers using solvents and increased review and enforcement of safety regulations regarding such use of solvents.

Background: Amphotericin B Deoxycholate (ABD) has been the best therapeutic agent for treatment of most systemic fungal infections. However, untoward adverse effects like nephrotoxicity may limit its appropriate therapeutic use. We studied administration of fat emulsion early after infusion of ABD to evaluate its effects on ABD-associated nephrotoxicity.
Methods: This study was a randomized clinical trial. Patients with fungal infections admitted in Amir-Alam and Imam-Khomeini University Hospitals, Tehran, Iran, entered the study during 1390- 1391. The patients were randomized to intervention and control groups. In both groups, patients received 1mg/kg/day ABD in dextrose 5%. In intervention arm, the patients additionally received intralipid 10% daily that was started as soon as possible within one hour after infusion of ABD. ABD-associated nephrotoxicity (a minimum 50% increase in baseline serum creatinine to a minimum of 2mg/dl), daily serum creatinine changes during first two weeks of treatment and some other relevant indices of renal function were compared between groups. ABD-related hypokalemia was also compared as an additional target.
Results: Thirty one patients entered the study. ABD-associated nephrotoxicity and values of other relevant indices of renal function were not different between intervention and control groups (P>0.05). Daily changes in serum creatinine level within first two weeks of treatment in both groups were not also statistically different (P=0.62). Furthermore, ABD-related hypokalemia was not significantly different between groups (P=0.47).
Conclusion: Administration of intralipid 10% early after infusion of ABD in dextrose 5% does not have any effect in decreasing ABD-associated nephrotoxicity. Moreover, it does not have any significant effect on ABD-related hypokalemia.