Phillips S C, Petrone R L, Hemstreet G P
Department of Urology, University of Oklahoma College of Medicine, Oklahoma City 73190.
Occup Med. 1988 Jul-Sep;3(3):495-509.
This review has demonstrated that there is a considerable amount of information in the medical literature concerning hydrocarbon-associated kidney effects. The existing data lends itself to a variety of divergent interpretations. Ravnskov has stated that "glomerulonephritis should be recognized legally as an occupational disease," yet there is no mention of hydrocarbon exposure in the differential diagnosis of glomerulonephritis in two standard American textbooks of internal medicine. Two recently published textbooks of occupational medicine state without reservation that "studies have linked hydrocarbon exposure to glomerulonephritis" and base this conclusion on the previously cited studies of Beirne and Brennan, Zimmerman, and Ravnskov. Based on this review, the following conclusions have been reasonably substantiated: 1. Massive exposure to petroleum distillates on rare occasions may cause acute renal failure due to tubular necrosis. This appears to be a reversible lesion which, depending on the level of exposure, the medical care and support available, and pre-existing renal function, may be without chronic sequelae. 2. Case reports linking Goodpasture's syndrome and other types of glomerulonephritis to hydrocarbon exposure are based on circumstantial evidence and cannot be used to establish a causal association. 3. The evidence from the eight case-control studies of hydrocarbon exposure and glomerulonephritis is inconclusive. Six of the eight published case-control studies show a positive association between hydrocarbon exposure and glomerulonephritis, but four of the six studies have methodologic flaws that could explain the observed effect. The findings in the one positive study that is methodologically acceptable were not replicated in a subsequent study utilizing a similar design. 4. Studies of hydrocarbon-exposed occupational cohorts have generally revealed a lower than expected risk of death from renal causes. As with most historical cohorts, the specific exposures, intensities and durations of exposure have been poorly defined. Effects of mortality that may occur among highly exposed subsets of these occupational cohorts may be diluted by a relatively large proportion of workers with minimal or no exposure to the class of hydrocarbons in question. 5. Studies of renal biochemistry and renal function effects have been uniformly negative in groups of workers from several industries with relatively high exposures of long duration to a variety of hydrocarbon solvents. The statistically significant differences in proteinuria and cell excretion observed in one of the studies should not be confused with clinical significance.(ABSTRACT TRUNCATED AT 400 WORDS)
