Aluminum toxicity in chronic renal failure
Jones, B.; Epstein, M.
Clinical Nephrology 33(5): 257
1990
ISSN/ISBN: 0301-0430 PMID: 2354566 Document Number: 352925
Aluminium is the most abundant metal and the third most common element in the earth's crust. It is a normal constituent of vegetables, and animal tissues, is present in water and a variety of salts of aluminium are widely used in foods, fluids and medications. During the past two decades it has been recognized that the tissue accumulation of aluminium, with the development of associated toxic phenomena, occurs both in children and adults with varying degrees of impaired renal function. In adults with chronic renal failure, the accumulation and toxic phenomena develop predominantly in those who are having long-term treatment with either haemo- or peritoneal dialysis. In children, aluminium accumulation and toxic phenomena occur predominantly in those with either immature or impaired renal function who are being treated with aluminium-containing phosphate-binding agents. It also occurs in premature infants following the use of aluminium-contaminated intravenous and parenteral solutions. The clinical toxic phenomena associated with an increased tissue content of aluminium include a specific form of encephalopathy (dialysis encephalopathy), a specific metabolic bone disease (osteomalacic dialysis osteodystrophy) and a microcytic hypochromic anaemia. The potential risk of aluminum toxicity in both adults and children, with impaired renal function, can be avoided by the cautious use of aluminium-containing oral phosphate-binding agents and regular monitoring of the aluminium content of those sources which have been identified as major risk factors and to which these patients are exposed. Regular monitoring of the serum concentration of aluminium is also critical in any patient with impaired renal function who is potentially exposed to aluminium and is thus at risk. Aluminium toxicity can be treated with deferoxamine which acts by mobilizing aluminium in tissues, probably by chelation and rendering the metal ion available for elimination from the body.