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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Am+Soc+Nephrol
2007 ; 18
(1
): 274-81
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Effect of organic solvent exposure on chronic kidney disease progression: the
GN-PROGRESS cohort study
#MMPMID17135394
Jacob S
; Héry M
; Protois JC
; Rossert J
; Stengel B
J Am Soc Nephrol
2007[Jan]; 18
(1
): 274-81
PMID17135394
show ga
It has been suggested that solvent exposure may have a role in the progression of
glomerulonephritis (GN) to ESRD, but this has never been tested with an
appropriate cohort study design. A total of 338 non-ESRD patients with a first
biopsy for primary GN between 1994 and 2001 were included: 194 IgA nephropathies
(IgAN), 75 membranous nephropathies (MN), and 69 FSGS. ESRD, defined as an
estimated GFR <15 ml/min per 1.73 m2 or dialysis, was registered during a mean
follow-up period of 5 yr. Patients' lifelong solvent exposures before and after
diagnosis were recorded by interview and assessed by industrial hygienist
experts. Cox models were used to estimate adjusted hazard ratios (HR) of ESRD
related to exposures. Overall, 15 and 14% of the patients had been exposed at a
low and a high level before diagnosis, respectively. Forty-two with IgAN, 12 with
MN, and 22 with FSGS reached ESRD. A graded relationship was observed for MN
(age- and gender-adjusted HR [95% confidence interval] for low exposure versus
none was 3.1 [0.5 to 18.2] and for high exposure versus none was 8.2 [1.9 to
34.7]) and for IgAN (1.6 [0.7 to 3.9] and 2.2 [1.0 to 4.8]) but not for FSGS.
Solvent risk was mediated only partly by baseline proteinuria: Adjusted HR for
high exposure versus none was 5.5 (1.3 to 23.9) for MN and 1.8 (0.8 to 3.9) for
IgAN. In patients with IgAN, there was a trend in increasing HR with exposure
duration before and its persistence after diagnosis. These findings support the
hypothesized association of solvent exposure with the progression of GN to ESRD.
They should prompt clinicians to give greater attention to patients' occupational
exposures and possibly to consider professional reclassification.
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