Table Of ContentALUMINUM AND RENAL FAILURE
DEVELOPMENTS IN NEPHROLOGY
Volume 26
The titles published in this series are listed at the end a/this volume.
Aluminum and renal failure
edited by
MARC E. DE BROE
University Hospital Antwerp, Edegem, Belgium
JACK W. COBURN
University of California, Los Angeles, USA
Kluwer Academic Publishers
Dordrecht / Boston / London
Library of Congress Cataloging in Publication Data
Aluminum and renal failure I edited by Marc E. de Broe and Jack W.
Coburn.
p. cm. -- (Developments in nephrology 26)
ISBN 0-7923-0347-4 (U.S.)
1. Hemodialysis--Comp11cations and sequelae. 2. Aluminum
-Toxicology. 3. Chronic renal fai lure--Treatment--Complications and
sequalea. 1. De Broe. M. E. (Marc E.) II. Coburn, J. W., 1932-
III. Series.
RC901.7.H45A38 1989
617.4·61059--dc20 89-19883
ISBN-13:978-94-0 10 -7333-2 e-ISBN-13:978-94-009-1868-9
DOl: 10.1007/978-94-009-1868-9
Printed on acid free paper
Published by Kluwer Academic Publishers,
P.O. Box 17,3300 AA Dordrecht, The Netherlands
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All Rights Reserved
© 1990 by Kluwer Academic Publishers
Softcover reprint of the hardcover 1 st edition 1990
No part of the material protected by this copyright notice may be reproduced or
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Contents
List of authors vii
GENERAL
Historical survey of aluminum-related diseases
M.E. de Broe & P.C. D'Haese 1
Chemistry of aluminum
R.B. Martin 7
The metabolism of aluminum
F.L. van de Vyver, P.C. D'Haese & M.E. de Broe 27
Intestinal absorption of aluminum
F.A. de Wolff & G.B. van der Voet 41
Aluminum determination in biological samples
C.D. Hewitt, M.R. Wills & J. Savory 57
Quality control of aluminum measurements
A. Taylor 75
PATHOPHYSIOLOGY
Pathophysiologic mechanisms of aluminum toxicity: Aluminum
induced bone disease
W. G. Goodman 87
Aluminum encephalopathy: Experimental vs human
O. Bugiani & B. Ghetti 109
Alzheimer's disease: Aluminum and fibrinous proteins
D. R. Crapper McLachlan 127
Aluminum interaction with macromolecules and membranes
M. Cochran, J.H. Coates & D.C. Elliott 139
Cellular and subcellular localization of aluminum: Histochemistry
A.J. Freemont 155
Cellular and subcellular localization of aluminum
B.F. Boyce 167
Experimental models of aluminum toxicity
N. C. Blumenthal & J. C. Grew 179
Vl
CLINICAL
Sources of aluminum
S.M. Ott 189
Unusual sources of aluminum
G. L. Klein 203
Experimental aluminum induced bone disease
M. Rodriguez, A.l. Felsenfeld & F. Llach 213
Aluminum induced bone disease: Clinical features
D.l. Sherrard 231
Aluminum induced bone disease: Histology
W.l. Visser 241
Dialysis encephalopathy
A.c. Alfrey & D.C. Froment 249
Other clinical syndromes associated with aluminum. Microcytic
anemia, joint pain, severe infections, liver dysfunction
T.B. Driieke 259
Aluminum toxicity in childhood
A.B. Sedman & G.L. Klein 267
Occupational exposure to aluminum and its compounds and their
health effects
C-G. Elinder & B. Sjogren 275
DIAGNOSIS
The Diagnosis of aluminum toxicity
1. Cannata Andia & 1. B. Diaz L6pez 287
TREATMENT
Deferoxamine therapy of aluminum toxicity in dialysis patients
S.A. Charhon 309
Alternative phosphate binders for aluminum hydroxide
A. Fournier, P. Moriniere, B. Boudailliez, H. Renaud, C.
Hocine, S. Belbrik & P.F. Westeel 325
Risk factors for aluminum toxicity and its prevention
1.W. Coburn & W.G. Goodman 345
Index of subjects 000
List of authors
Allen C. ALFREY, Veterans Administration Medical Center, 1055 Cler
mont Street, l11C, Denver, CO 80220, U.S.A.
Said BELBRIK, Service de Nephrologie, CHU, 80030 Amiens, France
Norman C. BLUMENTHAL, Department of Bioengineering, Hospital for
Joint Diseases Orthopaedic Institute, 301 East 17th Street, New York, NY
10003, U.S.A.
Bernard BOUDAILLIEZ, Service de Nephrologie, CHU, F-80030 Amiens,
France
Brendan F. BOYCE, University of Glasgow, Department of Pathology,
Royal Infirmary, Glasgow G4 OSF, Scotland, U.K.
Orso BUGIANI, Neurology Institute Carlo Besta, 11 Via Celoria, 1-20133
Milano, Italy
Jorge B. CANNATA ANDIA, Unidad de Investigaci6n, Hospital General
de Asturias, Apartado 243, Oviedo, Spain
Sam A. CHARHON, INSERM U. 234, Faculte A. Carrel, Rue Guillaume
Paradin, F-69008 Lyon, France
John H. COATES, Department of Physical and Inorganic Chemistry, Uni
versity of Adelaide, Adelaide 5001, Australia
Jack W. COBURN, Nephrology Section (WI11L) , VA Medical Center West
Los Angeles, Wilshire and Sawtelle Blvds, Los Angeles, CA 90073, U.S.A.
Malcolm COCHRAN, Deparment of Medicine, Flinders Medical Center,
Bedford Park 5042, Australia
Marc E. DE BROE, University of Antwerp, Department of Nephrology
Hypertension, University Hospital Antwerp, Wilrijkstraat 10, B-2520
Edegem, Belgium
Frederik A. DE WOLFF, Toxicology Laboratory, University Hospital
Leiden, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
Patrick C. D'HAESE, University of Antwerp, Department of Nephrology
Hypertension, University Hospital Antwerp, Wilrijkstraat 10, B-2520
Edegem, Belgium
Jose B. DIAZ LOPEZ, Research Unit, Hospital General de Asturias,
Universidad de Oviedo, Apartado 234, Oviedo 33080, Spain
Tilmann B. DRUEKE, Department of Nephrology, Hospital Necker, 161
Rue de Seires, F-75743 Paris Cedex 15, France
Carl-G. ELINDER, Department of Renal Medicine, Huddinge University
Hospital, Karolinska Institute, S-141 86 Huddinge, Sweden
Daphne C. ELLIOTT, School of Biological Sciences, Flinders University,
Bedford Park 5042, Australia
Vlll
Arnold J. FELSENFELD, Section of Nephrology (l11G), University of
Oklahoma Health, Sciences Center and VAMC, 921 N.E. 13th Street,
Oklahoma City, OK 73104, U.S.A.
Albert FOURNIER, Service de Nephrologie, CHU, 80030 Amiens, France
Anthony J. FREEMONT, Department of Rheumatology, University of
Manchester Medical School, Oxford Road, Manchester, United Kingdom
Daniel C. FROMENT, Veterans Administration Medical Center, 1055 Cler
mont Street, 111C, Denver, CO 80220, U.S.A.
Bernardino GHETTI, Indiana University School of Medicine, 1100 W.
Michigan St. Indianapolis, IN 46202, U.S.A.
William G. GOODMAN, Nephrology Section (111R), Sepulveda Veterans
Administration, Medical Center, 16111 Plummer Street, Sepulveda, CA
91343, U.S.A.
John C. GREW, Department of Histology and Cell Biology, New York
University Dental Center, 345 East 24th Street, New York, NY 10010,
U.S.A.
Caroline D. HEWITT, Department of Internal Medicine, Box 168, Univer
sity of Virginia Medical Center, Charlottesville, VA 22908, U.S.A.
Choukri HOCINE, Service de Nephrologie, CHU, 80030 Amiens, France
Gordon L. KLEIN, Department of Pediatrics, University of Texas Medical
Branch, Galveston, TX 77550, U.S.A.
J. D. LALAU, Service de Nephrologie, CHU, 80030 Amiens, France
Francisco LLACH, Section of Nephrology (l11G), University of Oklahoma
Health, Sciences Center and VAMC, 921 N.E. 13th Street, Oklahoma
City, OK 73104, U.S.A.
R. Bruce MARTIN, Chemistry Deparment, University of Virginia, Charlot
tesville, VA 22903, U.S.A.
Donald R. CRAPPER McLACHLAN, University of Toronto, Faculty of
Medicine, 3318 Medical Sciences Building, Toronto, Canada M5S 1A8
Philippe MORINIERE, Service de Nephrologie, CHU, 80030 Amiens,
France
Susan M. OTT, Department of Medicine, University of Washington, Harbor
view Medical Center, ZA-67, 325 Ninth Avenue, Seattle, WA 98195,
U.S.A.; present address: Department of Nuclear Medicine, RC-70, Uni
versity of Washington, Seattle WA 98195, U.S.A.
Henri RENAUD, Service de Nephrologie, CHU, F-80030 Amiens, France
Mariano RODRIGUEZ, Section of Nephrology (l11G), University of Okla
homa Health, Sciences Center and VAMC, 921 N.E. 13th Street, Okla
homa City, OK 73104, U.S.A.
John SAVORY, Deparment of Pathology, Box 168, University of Virginia
Medical Center, Charlottesville, VA 22908, U.S.A.
Aileen B. SED MAN, University of Michigan Medical Center, Pediatric
IX
Nephrology, Room 1924/Box 0318, A. Alfred Taubman Health Care
Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0318,
U.S.A.
Donald J. SHERRARD, Veterans Administration Medical Center, 1660, So.
Columbian Way, Seattle, WA 98108, U.S.A.
Bengt SJOGREN, Section of Occupational Medicine, Research Department,
National Board of Occupational Safety and Health, S-171 84 Solna,
Sweden
Andrew TAYLOR, Trace Metals Laboratory, Robens Institute of Industrial
and Environmental Health and Safety, University of Surrey, Guildford,
Surrey GU2 5XH, U.K.
and Department of Clinical Biochemistry and Nutrition St. Luke's Hospital
Guildford, Surrey GUl 3NT
Walter J. VISSER, Clinical Research Group for Bone Metabolism, Depart
ment of Internal Medicine, University Hospital, Catharijnesingel101, 3511
GV Utrecht, The Netherlands
Gijsbert B. VAN DER VOET, Toxicology Laboratory, University Hospital
Leiden, Rijnsburgersweg 10, 2333 AA Leiden, The Netherlands
Frank L. VAN DE VYVER, University of Antwerp, Department of
Nephrology-Hypertension, University Hospital Antwerp, Wilrijkstraat 10,
B-2520 Edegem, Belgium
Pierre-Fran<;ois WESTEEL, Service de Nephrologie, CHU, F-80030 Amiens,
France
Michael R. WILLS, Department of Internal Medicine, Box 168, University
of Virginia Medical Center, Charlottesville, VA 22908, U.S.A.
Historical survey of aluminum-related diseases
MARC E. DE BROE AND PATRICK C. D'HAESE
1856: Charles Dickens reports about a newly available metal: 'Aluminium'
[23].
1880: Smith notes that feeding aluminum-containing baking powder to dogs
results in an increase in organ aluminum [40].
1886: A practical method of manufacturing aluminum is patented by Hall
and Heroult [23].
1913: The Lancet describes the culinary and chemical impact of aluminum in
the kitchen [5, 6].
1938: Pulmonary aluminosis due to exposure to submicron-sized aluminum is
seen in Germany by Doese [20].
1940-1945: Cheaper electricity makes the metal available on a massive scale
[23].
1940's: Aluminum inhalation is practised as a method of preventing curing
silicosis [16].
1950-1960' s: Aluminum is being used as a phosphate binder in chronic
renal failure [23].
1957: After reviewing 503 references, Campbell et al. conclude that alumi
num presents a hazard in only a few special circumstances [11].
1962: Features comparable to the later on so-called dialysis encephalopathy
are observed by McLaughlin and co-workers in a 49 years old men who
inhaled aluminum dust in a factory making aluminum powder [28].
1965: Kerr and his colleagues report to the Renal Association a bone disease
characterized by bone demineralization as observed on radiographs [23].
1965: Klatzo and co-workers show that intracerebrally injection of aluminum
compounds into rabbits induces neurofibrillary changes being highly com
parable to the characteristics of Alzheimer's disease [24].
1968: Schorr describes the features of the so-called 'Newcastle Bone Disease'
[36].
1968: Chugh and colleagues try an aluminum resin for the treatment of the
hyperkalaemia of renal failure [12].
