Renal effect

Permanent morphological changes in renal structure have been reported in patients who have experienced lithium toxicity (Markowitz et al. 2000). Case reports of irreversible renal failure as a result of chronic, nontoxic lithium therapy are extremely rare and typically foUow 10 or more years of treatment, during which time the patient s serum creatinine levels have gradually increased (e.g., to 2.0 mg/100 mL Gitlin 1993). To minimize the risk of renal complications, which are rare but potentially serious, we recommend frequent patient education about the risks of toxicity and factors that might make toxicity more likely, such as drug interactions or dehy- 

Adverse effects of lead exposnre on renal funetion were first described in the 19th century (Lanceraux 1881). There is now a voluminous hterature on the relationship between environmental and occnpational lead exposure and renal function. It includes many epidemiologic stndies and a broad array of mechanistic toxicology studies in animal models. 

Healtii Effect Population Characteristics Measures Effect Estimate Why Study Is Relevant to DOD Reference 

Shortened erythrocyte survival Battery and smelter workers (n = 17) and controls (n = 4) Urinary coproporphyrin 500 pg/L Erythrocyte survival was 101 days in workers vs 120 days in controls. Clinically important outcome. Hemberg et al. 1967 

Anemia Smelter workers and a chemicals plant (n = 160) BLLs about 50 pg/dL Anemia (Hgb 14 g/dL) seen in 21% of workers. Clinically important outcome. Baker et al. 1979 

Decreased erythrocytes, HCT, and Hgb Various industries in Japan Estimated benchmark doses of about 20 pg/dL for hemoglobin, erythrocytes, about 30 pg/dL for HCT Onsets of declines in these measures begin at these BLLs. Facilitates risk assessment, management decisions. Karita et al. 2005 

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Yohimbine (104), also from the bark of C.johimbe K Schum. and from the roots of R. serpentina (1. ) Benth. has a folk history (unsubstantiated) of use as an aphrodisiac. Its use has been confirmed experimentally as a local anesthetic, with occasional employment for rehef ia angiaa pectoris and arteriosclerosis, but is frequently contraindicated by its undesired renal effects. Yohimbine and some of its derivatives have been reported as hahuciaogenic (70). In addition, its pattern of pharmacological activities ia a variety of animal models is so broad that its general use is avoided. All ten carbon atoms of secologanin (102) as well as the entire skeleton of tryptamine (98, R = H) are clearly seen as iatact portions of this alkaloid. 

No studies were located regarding gastrointestinal, hematological, musculoskeletal, or dermal effects in humans or animals after inhalation exposure to methyl parathion. Dean et al. (1984) reported that seven children exposed to methyl parathion by many routes exhibited pinpoint pupils, abdominal pain, and diarrhea. The respiratory, cardiovascular, hepatic, and renal effects reported by Fazekas (1971) that were found in humans acutely exposed to methyl parathion intoxication resulted from exposure by all three routes however, the results did not distinguish between the routes. 

Renal Effects. Kidney lesions were reported in humans dying of acute methyl parathion (Wofatox) intoxication (Fazekas 1971). See Section S.2.2.2 for a description of these lesions. 

No studies were located regarding renal effects in animals after inhalation exposure to methyl parathion. 

Renal Effects. Acute nephrosis has been reported in humans after acute, lethal intoxication (Fazekas 1971) by methyl parathion (Wofatox). This may be a secondary effect of hypoxia related to the neurologic effects of methyl parathion on vascular smooth muscle and on the electrical conduction system of the heart. It could also be related to therapeutic efforts. 

Routine gross and histopathological examinations revealed no treatment-related effects on the renal system of dogs exposed to 0.03, 0.1, or 0.3 mg/kg/day methyl parathion in the diet for 1 year (Suba 1981). Chronic dietary exposure to methyl parathion did not induce renal effects in mice fed... 

No studies were located in humans or animals regarding respiratory, gastrointestinal, hematological, musculoskeletal, hepatic, or renal effects after dermal exposure to methyl parathion. 

Renal Effects. Hemorrhage of the medullary layer of the kidneys was reported in three persons who died following ingeshon of endosulfan (Terziev et al. 1974). Acute renal failure was a major contributor to the deaths of two individuals who ingested unknown amounts of endosulfan (Blanco-Coronado et al. 1992 Loetal. 1995). In both cases, postmortem examination revealed extensive tubular necrosis. In contrast, no kidney lesions were found in a man who died 4 days after ingesting approximately 260 mg endosulfan/kg (Boereboom et al. 1998). 

Renal Effects. Triehloroethylene may have effeets in the kidney however, studies in humans are limited by having poor or no exposure data and by concomitant exposure to other chemicals. There was no evidence of kidney damage in 250 neurosurgery patients who underwent prolonged trichloroethylene anesthesia (Brittain 1948), nor in 405 women who had caesarean sections and were exposed to trichloroethylene anesthesia (Crawford and Davies 1975). 

The COX-2 enzyme is also produced normally in the kidney thus COX-2 inhibitors exert renal effects similar to those of conventional NSAIDs. Both drug classes may increase sodium reabsorption and fluid retention and can provoke renal insufficiency and hyperkalemia. COX-2 inhibitors should be used with caution in patients with heart failure or hypertension. 

Renal Effects. Animal studies indicate that degenerative changes in the kidneys may result from acute inhalation exposure to 241 Am. Repeated intraperitoneal injection of241 Am resulted in histopathologic changes in the kidneys of rats. 

No data were located regarding respiratory effects, cardiovascular effects, gastrointestinal effects, hepatic effects, renal effects, endocrine effects, dermal effects, ocular effects, body weight effects, or metabolic effects in humans or animals following acute-, intermediate-, or chronic-duration dermal exposure to americium ... 

Renal Effects. No studies were located regarding renal effects in humans after inhalation, oral, or dermal exposure or in animals after dermal or inhalation exposure to diisopropyl methylphosphonate. 

Significant increases in serum urea nitrogen and serum creatinine levels (which may be indicative of impaired renal function) were observed in Pasteurella-infected rabbits exposed to 2,875 or 5,750 mg/kg/day of Fyrquel 220 for an intermediate duration (MacEwen and Vemot 1983). The results of the histological examination were not reported, and the renal effects of the infection were not discussed. 

No gross or histological alterations were observed in the kidneys of rabbits exposed to 1,000 mg/kg/day of cyclotriphosphazene (Kinkead et al. 1989c, 1990) or in rabbits exposed to an unspecified amount of Cellulube 220 for an intermediate duration (Carpenter et al. 1959). No studies examining renal effects following acute or chronic durations were located. 

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