Renal disease aluminium

We are all exposed to aluminium from the metal utensils we use and also from the occasional use of medicinal preparations such as antacids, but it is poorly absorbed and the risk is probably very small. Dialysis patients with renal disease were found to be at risk of brain damage due to the aluminium derived from the equipment. Realization of this led to a lowering of the exposure of such patients, which decreased the occurrence of toxic effects of aluminium. Patients on dialysis with end stage renal disease, in whom some accumulation of aluminium occurred, showed evidence of metabolic abnormalities and in psychomotor function. 

Guillard, O. and Pineau, A. (1986) The measurement of plasma aluminium by the worldwide inter-laboratory quality control aluminium study distribution and utilisation of the results. In Taylor, A. (Edit) Aluminium and other Trace Elements in Renal Disease, Bailliere Tindall, London, p. 283. 

Only a small amount of aluminum is absorbed, and is usually readily eliminated in the urine, unless renal function is impaired. Then absorbed Ap+ can contribute to osteoporosis, encephalopathy, and proximal myopathy. There is some concern that excess of aluminium may contribute to the development of Alzheimer s disease and other neurodegen-erative disorders. 

Care should be taken when administering aluminium salts such as aluminium hydroxide in patients with renal dysfunction and bone diseases. Patients with renal... 

A 39-year-old woman who took high doses of aluminium and magnesium hydroxide for peptic ulcer disease (over 18 kg of elemental aluminium and 15 kg of elemental magnesium over 8 years) developed severe osteomalacia due to profound phosphate depletion (60). Bone biopsy showed stainable aluminium deposits along 28% of the total bone surface, a unique observation in a patient with normal renal function. Treatment included withdrawal of the antacid and supplementation with phosphate, calcium, and vitamin D. Her bone mineral density increased over the next 2 years. 

Unexpected persistent aluminium-related bone disease occurred after renal transplantation following earlier use of aluminium hydroxide (62). 

A 59-year-old man presented with end-stage renal insufficiency. While on hemodialysis he had used aluminium hydroxide as a phosphate binder but then used calcium lactate instead after total parathyroidectomy. Oral vitamin D was discontinued after the parathyroidectomy. However, after he had received a renal transplant he developed aluminium-related bone disease and was treated with infusions of deferoxamine. 

This is the first report of worsening aluminium-related bone disease after renal transplantation. 

Hyperparathyroidism and aluminium hydroxide lead to aluminium-related bone disease however, total parathyroidectomy does not lead to failure of aluminium mobilization after renal transplantation. This man had satisfactory graft function, and the aluminium excretion that was achieved by deferoxamine suggests that the renal transplant was not the limiting factor for the mobihzation of aluminium. The most likely explanation was that he developed adynamic bone through a combination of vitamin D deficiency, hypoparathyroidism, and aluminium deposition. Vitamin D supplementation failed to prevent the osteodystrophy on its own. When aluminium chelation therapy was used, bone healing occurred and his symptoms improved. 

Nicholas JC, Dawes PT, Davies SJ, Freemont AJ. Persisting aluminium-related bone disease after cadaveric renal transplantation. Nephrol Dial Transplant 1999 14(l) 202-4. 

Dedman, D.J., Treffry, A., Candy, J.M., Taylor, G.A.A., Morris, C.M., Bloxham, C.A., Perry, R.H., Edwardson, J.A. and Harrison, P.M. (1992) Iron and aluminium in relation to brain ferritin in normal individuals and Alzheimer s disease and chronic renal-dialysis patients. Biochem. J. 181 509-514. 

During the 1970s, several publications in newspapers alleged that aluminium could lead to early senility and could be one of the factors responsible for Alzheimer s disease. In fact, the only reliable data show that aluminium has led to certain medical disorders in patients suffering from renal insufficiency and treated by renal dialysis [7]. These disorders have totally disappeared since dialysis techniques were modified. 

However, there is no doubt that aluminium can damage people whose kidney function is impaired. The condition called dialysis dementia was first noticed in patients who had received long-term haemodialysis for renal failure. Its symptoms included speech disorders, memory loss, convulsions and seizures, followed, in some cases, by death within a year. The incidence of the disease was highest when the municipal water used in the dialysis contained high concentrations of aluminium. Aluminium is, therefore, a potential neurotoxin. 

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