In rapidly progressive glomerulonephritis

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Jayne DR, Marshall PD, Jones SJ, et al. Autoantihodies to GBM and neutrophil cytoplasm in rapidly progressive glomerulonephritis. Kidney Int 1990 37 965-970. 

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During the past decade a number of case reports have described the occurrence of different forms of renal disease in patients exposed to silica [58-66]. However, only a few reports concerned subjects exposed to sihca but without silicosis. Most of the cases demonstrated renal lesions compatible with rapidly progressive glomerulonephritis with a necrotizing component present in most cases. Crescent formation was described in a patient with proliferative glomerulonephritis [59] and three individuals with IgA nephropathy [60]. 

Chronic renal failure as a result of toxic or environmental exposures usually involve progressive chronic interstitial nephropathy, which, in addition to prolonged analgesic abuse, may result from chronic lithium ingestion, heavy metal exposure or treatment with cyclosporine [2]. Exposure to hydrocarbons may accentuate the renal insufficiency in patients with preexisting renal disease or result in the appearance of the nephrotic syndrome or a form a rapidly progressive glomerulonephritis. 

Much less is known about renal injury and silicon exposure. A number of observations of the past few years have suggested a primary or secondary role for substances such as silicon-containing compounds in the development of ANCA (anti-neutrophU cytoplasmic antibodies)-associated rapidly progressive glomerulonephritis or Wegener s granulomatosis (Nuyts et al. 1995, De Broe et al. 1996). 

Other adverse effects are caused by immunological reactions, of which the drug-induced lupus syndrome is the most common. Hydralazine also can result in an illness that resembles serum sickness, hemolytic anemia, vasculitis, and rapidly progressive glomerulonephritis the mechanism of these autoimmune reactions is unknown. The drug-induced lupus syndrome usually occurs after at least 6 months of continuous treatment with hydralazine, and its incidence is related to dose, sex,... 

By summarizing various studies and case reports, Gregorini (working in Brescia) showed that extrapul-monary silicotic lesions and/or autoimmune processes may play a role in kidney diseases after silica exposure, more specifically MPO-ANCA-positive microscopic polyangiitis and its renal-limited form of idiopathic , rapidly progressive glomerulonephritis (Conrad et al. 

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