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M M Elseviers

Publications and source records attributed to M M Elseviers.

50 records · Page 3Linked to original sources
PubMed1993

Healthy worker effect in a cross-sectional study of lead workers.

To study the role lead may play in the development of renal disease, we performed a cross-sectional study of workers at a lead smelting plant. Renal function was defined based on calculated creatinine clearance using the prevalence of values under the 3rd percentile to compare groups. The prevalence of calculated creatinine clearance values under the 3rd percentile in these workers (n = 1782) as a whole was 2.81%, a result comparable to that which has to be expected for the general population. Closer analysis, however, showed significantly lower prevalence of calculated creatinine clearance under the 3rd percentile in certain subgroups of workers. These subgroups were workers between the ages of 30 and 39, workers over the age of 50, and Belgian workers who had worked in the plant for longer than 10 years. We conclude that these observations once more clearly demonstrate a "healthy worker effect" on the measurement of renal function in this work force, a major problem in epidemiologic cross-sectional studies.

Actuarial Analysis↗
PubMed1992

Diagnostic criteria of analgesic nephropathy in patients with end-stage renal failure: results of the Belgian study.

Diagnostic criteria of analgesic nephropathy with well-defined sensitivity and specificity are not available. During a 2-year period all new patients (n = 273) starting renal replacement therapy in 13 Belgian dialysis units were investigated aiming to select diagnostic criteria of analgesic nephropathy with acceptable performance. Using several interview techniques, a history of analgesic abuse was found in 31% of the patients. Analgesic abusers presenting a clear non-analgesic-related renal diagnosis were excluded from analysis (n = 25). Comparing the remaining abusers (n = 60) and patients without a history of analgesic abuse (n = 188) it was found that renal imaging investigations (sonography plus tomography), showing a decrease in length combined with bumpy contours of both kidneys, presented a sensitivity of 90% and a specificity of 95%. The additional finding of signs of renal papillary necrosis resulted in an overall sensitivity of 72% and a specificity of 97%, giving a positive predictive value of 92%. Other signs frequently mentioned in the literature (hypertension, anaemia, sterile pyuria, bacteriuria, proteinuria) showed insufficient sensitivity and/or specificity to be of help for diagnosing analgesic nephropathy in end-stage renal failure (ESRF) patients starting renal replacement therapy.

Adult↗
PubMed1991

Does lead play a role in the development of chronic renal disease?

For many decades lead has been considered to be one of the causes of chronic renal failure. A critical analysis of the available epidemiological studies, however, indicates that the relationship between lead exposure and the development of chronic renal failure is largely circumstantial. Indeed, several aspects remain obscure: relative and absolute risk, risk factors, duration of exposure, pathology and diagnostic criteria. Moreover, methodological problems related to cohort selection (i.e. the 'Healthy worker effect'), study design and definition of renal dysfunction may limit the value of the epidemiological results. Although the available literature suggests that lead may play a direct or contributory role in the development of chronic renal failure it is concluded that additional detailed epidemiological studies are required.

Case-Control Studies↗
PubMed1990

Value of serum aluminium monitoring in dialysis patients: a multicentre study.

The clinical relevance of regular serum aluminium monitoring in dialysis patients was investigated in a multicentre study by 6-monthly determination of the serum aluminium during 4 consecutive years. In a group totalling 1193 patients, a striking decrease of mean serum aluminium was observed the last 2 years of the study. This phenomenon was accompanied by a substantial reduction of the prescribed dose of aluminium hydroxide (Al(OH)3) and its partial replacement by calcium carbonate (CaCO3) and/or magnesium hydroxide (Mg(OH)2). Under this policy serum phosphate control remained satisfactory. In all the centres, water treatment was found to be adequate, yielding dialysate aluminium around 2 micrograms/l. Dialysis patients with clinically overt liver disease showed a significantly greater median serum aluminium concentration than that observed in a control dialysis population. Compared to the latter group, the median serum aluminium concentration of dialysis patients with diabetes mellitus did not differ significantly. Results further indicated that patients with biopsy-proven osteomalacia presented a significantly greater median serum aluminium compared to that of patients without osteomalacia. We demonstrated that a serum aluminium of 60 micrograms/l provides a relatively sensitive (82%) and specific (86%) index for the detection of aluminium-related bone disease (ARBD). Provided the aluminium determinations are performed by a qualified laboratory, serum monitoring in dialysis patients (a) allows the safer use of aluminium-containing phosphate binders, and (b) is of value in the diagnosis of overload/toxicity.

Adult↗
PubMed1989

Health impact of renal disease due to nephrotoxicity.

Both acute and chronic renal failure are reported in the context of nephrotoxicity. This overview of some major nephrotoxins reflects both the magnitude and the cost of this preventable health problem. Aminoglycosides and other antibiotics, contrast media and nonsteroidal anti-inflammatory drugs are the best documented nephrotoxins related to acute renal failure. Analgesic nephropathy is the best known drug-induced chronic renal disease. The cost of renal failure due to nephrotoxicity is not easy to compute. Drug-induced acute renal failure costs more than 2750 ECU per patient, depending on whether dialysis is required or not, and chronic renal failure costs at least 128,000,000 ECU annually in the European Communities. Recent epidemiological evidence, however, indicates that the cost may be even higher.

Acute Kidney Injury↗
PubMed1989

Epidemiology and mechanistic basis of analgesic-associated nephropathy.

End-stage renal failure (ESRF) due to analgesic nephropathy is still a common clinical condition in several countries, but the prevalence in dialysis patients shows large geographical differences. The frequency of ESRF of unknown aetiology is the inverse of that linked to analgesic abuse, and data suggest that the occurrence of analgesic nephropathy may be underestimated. The study of analgesic nephropathy is difficult because the earliest damage to the kidney is a renal papillary necrosis (RPN), which cannot easily be diagnosed. Continued analgesic abuse generally leads to a progressive secondary cortical degeneration which is easier to diagnose. If analgesic abuse is stopped at an early enough stage in nephropathy, clinical symptoms stabilize or improve, and ESRF may be averted. A high incidence of upper urothelial carcinoma (UUC) is also observed in individuals with a history of analgesic abuse, but it is still not clear if the two have a related pathogenesis. Study of the mechanism of RPN in animals administered analgesics and nonsteroidal antiinflammatory drugs (NSAID) has been difficult owing to their extrarenal toxicity. Several model compounds cause identical clinical changes and have as their selective target the renal medullary interstitial cells; subsequently, other changes (including cortical and glomerular degeneration) develop as a secondary cascade. A number of mechanisms have been proposed to explain RPN (e.g., counter-current concentrating mechanism, ischaemic injury, altered prostaglandin metabolism, immunological changes), but peroxidative metabolism of papillotoxic chemicals within the interstitial cells seems to be the most likely cause. Analgesic abuse is a costly socioeconomic condition for which there is currently no clinical treatment. If it is diagnosed early enough, severe renal degeneration can be prevented. Additional epidemiological information is needed to establish the causative role of analgesics and other chemicals, in order to determine the relative risk of each. Additional animal experiments are needed in order to clarify the molecular pathogenesis of RPN and UUC, to differentiate the stages in progression to ESRF and to develop more sensitive and selective diagnostic criteria.

Analgesics↗
PubMed1989

[Prevention of analgetics nephropathy].

Abuse of analgesics is associated with the development of renal damage which can lead to end stage renal failure. Moreover, an increased incidence of urothelial cancer is reported in abusers of analgesics. In Belgium, AN still remains a serious problem with a prevalence of 18% in dialysis patients. However AN is a preventable disease but in Belgium no adequate measurements were taken for prevention. The results of our study showed that AN is caused by the abuse of analgesic mixtures. Apart from the analgesic components, most mixtures contained caffeine. This component is considered as the principal causative agent in creating a psychic dependence to analgesics. Initially phenacetin was implicated as the nephrotoxic culprit. In recent years, however, it has become increasingly clear that phenacetin is unlikely to be the primary cause of AN. Moreover, abuse of phenacetin-containing analgesics does not exist any longer because the product is disappeared from the Belgian market. In view of the actual knowledge concerning AN, we will recommend that analgesic mixtures be put under prescription, limiting over-the-counter medication to single analgesics, in order to eliminate the occurrence of AN in Belgium.

Analgesics↗
PubMed1988

Bone lead in dialysis patients.

We measured lead and calcium in multiple bone biopsies from 11 cadavers without known excessive past exposure to lead. Paired iliac crest, transiliac and tibial bone biopsies from these cadavers indicated that in bone biopsy specimens the lead/calcium ratio is more reproducible than the absolute lead concentration. There were no significant differences between the lead/calcium ratios from the iliac crest, transiliac, or tibial specimens. Transiliac bone biopsies from 35 patients (13 patients showing symptoms of slight or moderate degree of renal failure, medical history of gout and/or arterial hypertension and 22 lead workers with chelatable lead in excess of 1000 micrograms) indicated that the lead and the lead/calcium ratio in bone biopsies reflect body lead stores as estimated by the EDT A test (r = 0.87 and 0.83, respectively). Chemical and histological studies of transiliac biopsies previously obtained from 153 dialysis patients (from 8 dialysis centers from Belgium, France and Germany) for studies of aluminum-induced bone disease showed that chronic renal failure and dialysis do not cause accumulation of lead in bone and elevated bone lead does not appear to alter trabecular bone histomorphometry. We found that in 5% of the hemodialysis population studied, bone lead concentrations approximated levels found in active lead workers.

Adult↗
PubMed1988

Is analgesic nephropathy still a problem in Belgium?

End-stage renal failure due to analgesic nephropathy still frequently occurs in Belgium. In a study conducted at the end of 1984 including 53 of the 54 dialysis centres, a prevalence of analgesic nephropathy in dialysis patients of 17.9% was found. The epicentre of the disease was situated in a small area in the northern part of the country, the southern part showed a clearly lower prevalence. The annual consumption of analgesic preparations in 1983 was approximatively 25 g per capita, in the north as well as in the south. In the north analgesic mixtures in powder form had an important market share in some particular areas, where the prevalence of end-stage renal failure due to analgesic nephropathy is the greatest. A general population survey (n = 855) showed that 83% of subjects had analgesic medications at home. Abuse of these drugs was found in 2.1% of the studied population. Abusers were mainly females most commonly taking analgesic mixtures.

Adult↗
PubMedDate not supplied

What can nephrologists learn from epidemiology?

During the last decade, epidemiology has played an increasing role in the study of renal diseases. In the fields of drug-nephrotoxicity and occupational renal failure, epidemiological research has made an important contribution. In recent years, the specific role of epidemiology in outcome research has gained recognition. Epidemiology is based on observations under real-life conditions using a representative sample of renal patients. Methods range from simple clinical observations and cross-sectional studies to case-control and prospective cohort studies. Contributions and limitations of the different epidemiological approaches are illustrated using the example of the nephrotoxicity of 5-aminosalicylic acid in patients with inflammatory bowel disease.

Case-Control Studies↗