Organic Solvents and the Kidney

Organic Solvents and the Kidney: Antonio Mum. Laboratory of industrial Toxicology, University of Parma Medical School —The association between solvent exposure and chronic glomerulonephritis is still a controversial scientific issue. Almost all published case‐referent studies consistently show an association between chronic glomerulonephritis and exposure to volatile hydrocarbons. Two nested prospective studies and a recent case‐referent study also suggest a role of solvent exposure in the progression of renal changes towards chronic renal failure. Cross‐sectional studies carried out in groups of workers exposed to relatively low concentrations of single solvents or mixtures demonstrate tubular damage frequently associated with high molecular weight proteinuria and changes in the glomerular basal membrane. In some studies, immunological disturbances (increased titer of antilaminin and/or anti‐glomerular basement membrane antibodies) have been found. Whereas unequivocal evidence of solvent‐induced renal disturbances is apparent on a group basis, the health significance of such changes is difficult to assess at the individual level. Although renal cancer in the male rat chronically exposed to a variety of hydrocarbons including several organic solvents is not a good model for assessing human risk, experimental studies may not be used as a proof to exclude the cancerogenic properties of all organic solvents. Indeed, epidemiological investigations suggest that a small excess mortality from renal‐cell cancer may occur as a consequence of exposure to some organic solvents, including dry‐cleaning products and petroleum‐derived hydrocarbons. Despite consistent results indicating renal effects of solvent exposure, no specific agents appeared to be implied more frequently, neither dose‐ effect nor dose response relationships were found and, finally, possible risk factors accounting for an increased individual susceptibility were not identified. Early markers of renal damage are very useful to identify groups at risk, since these subtle abnormalities may represent an early stage of clinically silent but potentially progressive renal diseases. Follow‐up should confirm the observed changes and assess their course and prognostic meaning. Repeatedly positive markers of renal damage also indicate the need for intervention, including job counseling and removal from exposure.