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Review
. 2017 Dec;10(6):747-758.
doi: 10.1093/ckj/sfx062. Epub 2017 Jul 28.

Environmental toxin-induced acute kidney injury

Benjamin A Vervaet  1 , Patrick C D'Haese  1 , Anja Verhulst  1
Affiliations
Review

Environmental toxin-induced acute kidney injury

Benjamin A Vervaet et al. Clin Kidney J. 2017 Dec.

Abstract

Human beings are exposed to various potentially toxic agents and conditions in their natural and occupational environments. The kidney, due to its concentrating ability and excretory function, is highly vulnerable to the effects of environmental toxins. Identifying the precise cause and mechanisms of environmentally induced renal injury remains a challenge for which various scientific disciplines need to be involved. Investigations in this field are confronted with the apparent infinite types of toxins, their mutual interaction, handling/metabolization by the body, ways of exposure, etc. Although interdisciplinary efforts and persistence are required to identify, mechanistically unravel and tackle environmental toxin-induced pathologies, research eventually pays off in ameliorated working/living conditions and development of preventive/therapeutic strategies. This review was compiled to particularly emphasize the need for a maintained awareness of environmental threats in general and those targeting the kidney. Different mechanisms of renal toxicity are illustrated and discussed, thereby focusing on three types of environmental toxins, namely aristolochic acid, melamine and heavy metals.

Keywords: aristolochic acid; heavy metals; melamine; nephropathy.

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Figures

Fig. 1.
Fig. 1.
CHN/AAN is a rapidly progressive interstitial nephritis leading to ESRD and urothelial malignancy that was originally reported in Belgium in the context of the intake of slimming pills containing powdered Chinese herbs (Aristolochia fangchi). (A) Countries with reported cases of CHN/AAN around the world. (B) Masson’s trichrome staining shows the deposition of extracellular matrix in blue/green. (C) Example of a traditional mixture of Chinese herbs.
Fig. 2.
Fig. 2.
Structure formula of melamine and its analogues.
Fig. 3.
Fig. 3.
Hydrogen-bonded interaction between melamine and cyanuric acid/uric acid.
Fig. 4.
Fig. 4.
Mechanisms involved in the uptake and action of aristolochic acid, melamine and the heavy metals Cd, Pb and Hg along the nephron. Adapted from Barbier et al. [111] with permission.
See this image and copyright information in PMC

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