Occupational solvent exposure and glomerulonephritis. A case report and review of the literature.

We describe a patient who presented with renal failure after a one-year period of unprotected heavy occupational exposure to organic solvents. Renal biopsy results and serological findings were diagnostic of anti-glomerular basement membrane antibody-mediated glomerulonephritis. An analytic review of the literature revealed substantial evidence linking solvent exposure to the development of glomerulonephritis (GN), with seven of nine case-control studies demonstrating a statistically significant association. Odds ratios were reported by or could be calculated for six of these studies, and the five positive studies detected a 2.8- to 8.9-fold increased risk for GN among solvent-exposed individuals. The findings in several of these studies of dose-response relationships, the reports of variations in disease severity in relation to exposure intensity, and the absence of alternative explanations for the association provide additional supportive evidence for a solvent effect. In the majority of cases of anti-glomerular basement membrane antibody-mediated GN and other types of GN, there is no remarkable preceding exposure to organic solvents. However, we conclude that in the case presented herein and in cases of GN with similar exposure histories, solvent exposure may play a significant contributing role in the development of GN.