Neurotoxicity dialysis encephalopathy

Katz GV Metals and metalloids other than mercury and lead, in Neurotoxicity of Industrial and Commercial Chemicals, Vol 1. Edited by O Donoghue JL. Boca Raton, FL, CRC Press, 1985, pp 171-191 Katzman R Alzheimer s disease. N Engl J Med 314 964-973, 1986 Klatzo I, Wisniewski H, Streicher E Experimental production of neurofibrillary degeneration. J Neuropathol Exp Neurol 24 187-199, 1965 Lederman RJ, Henry CE Progressive dialysis encephalopathy. Ann Neurol 4 199-204, 1978... 

Rozas VV, Port FK, Easterling RE An outbreak of dialysis dementia due to aluminum in the dialysate. Journal of Dialysis 2 459-470, 1978a Rozas W, Port FK, Rutt WM Progressive dialysis encephalopathy from dialysate aluminum. Arch Intern Med 138 1375-1377, 1978b Scherp HW, Church CF Neurotoxic action of aluminum salts. Proc Soc Exp Biol Med 36 851-853, 1937... 

It remains remarkable that, after the discovery of chronic Al encephalopathy and numerous reports of patients suffering from this syndrome, fourteen years passed before the first publication on acute Al neurotoxicity appeared [62], Acute Al encephalopathy is a devastating, often fatal disease that is the result of iatrogenic exposure to Al. Unfortunately, in spite of efforts to avoid Al exposure as much as possible, recently new sources of serious exposure have been added to the growing list of sources of Al exposure. In contrast to a fascinating history and abundant literature, many uncertainties about Al toxicity still exist. Clinical data in humans on acute Al neurotoxicity are very limited and we will, therefore, compare our experience in one of the two documented outbreaks in dialysis centers, with that of the literature. 

Pediatric patients are particularly at risk for Al neurotoxicity. The development of the brain occurs in the first year of life. High permeability of the immature blood-brain barrier to Al, the increased uptake of Al via a relatively poorly developed gastrointestinal tract, immature formation and function of the kidneys and high Al to body ratios probably all contribute to the Al toxicity [144, 145, 162-165], Children not on dialysis were intoxicated by Al-containing phosphate binders and developed encephalopathy [78, 162, 164, 166, 167],... 

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