Occupational Renal & Reproductive Diseases Dr Omid Aminian

Occupational Renal Diseases Acute renal dysfunction : Acute renal dysfunction : Acute tubular necrosis Acute tubular necrosis Organic solvent – heavy metals – arsine Organic solvent – heavy metals – arsine Chronic renal dysfunction: Chronic renal dysfunction: Chronic interstitial nephritis Chronic interstitial nephritis heavy metals - Organic solvent – silica heavy metals - Organic solvent – silica Nephrotic syndrome: Nephrotic syndrome: mercury mercury

Important nephrotoxins Metals: Metals: Lead – mercury – cadmium – chromium Lead – mercury – cadmium – chromium Solvents : Solvents : Halogenated hydrocarbon Halogenated hydrocarbon CCl4, trichloroethylene CCl4, trichloroethylene Non Halogenated hydrocarbon Non Halogenated hydrocarbon Toluene, phenol, monoethylether Toluene, phenol, monoethylether Others: Others: Arsine, silica, phosphors Arsine, silica, phosphors

Screening Tests BUN, Cr : is inadequate do not become abnormal BUN, Cr : is inadequate do not become abnormal until significant renal damage until significant renal damage High molecular weight proteinuria : High molecular weight proteinuria : Albumin, ferritin Albumin, ferritin Low molecular weight proteinuria : Low molecular weight proteinuria : B2 microglobuline, Retinol binding protein B2 microglobuline, Retinol binding protein Enzymuria: Enzymuria: N-acetyl glucose aminidase, LDH N-acetyl glucose aminidase, LDH

Reproductive Toxicity First occupational reproductive hazard Percival Pott but not taken seriously until First occupational reproductive hazard Percival Pott but not taken seriously until 1975 lead exposed male workers in Romania 1977 DBCP in exposed male workers in California 1975 lead exposed male workers in Romania 1977 DBCP in exposed male workers in California

Reproductive Toxicity REPRODUCTIVE FUNCTION REPRODUCTIVE FUNCTION Women Who Are Pregnant Women Who Are Pregnant Women of Child Bearing Age Women of Child Bearing Age Men Men

Reproductive Toxicity Difficulty in studying repro toxicity in women nature of the female cycle nature of the female cycle relative frequency spontaneous abortions relative frequency spontaneous abortions common occurrence of birth defects in general population common occurrence of birth defects in general population

Adverse Male Reproductive Effects of Selected Agent Agent Out come Strength Alcoholazoospermia + Boronoligospermia + chloropreneasthenospermia LeadOligospermia Mercury Decrease libido + Microwaveoligospermia + Excessive heat oligospermia + Ion-radiationoligospermia ++ ++

Adverse Female Reproductive Effects of Selected Agent Agent Out come Strengt h ArsenicSAB-LBW + Carbon monoxide SAB- menstrual dis + Mercury SAB- LBW CNS malformation LeadSAB-infertility Organic solvent SAB- menstrual dis +/? +/? VDT SAB - BDs Physical stress Preterm LBW-SAB- +/? +/?