Correlation of drug-related aluminum intake and dialysis treatment with deposition of argyrophilic aluminum-containing inclusions in CNS and in organ systems of patients with dialysis-associated encephalopathy.

CNS tissue and peripheral organs of 50 autopsy cases with chronic renal failure (CRF) and dialysis treatment were evaluated for aluminum- (Al) containing argyrophilic inclusions using the Howell and Black method modified by Reusche. Morphological alterations were correlated with the duration of hemodialysis (HD) and to the amount of prescribed Al-containing drugs for better control of hyperphosphatemia. Significant correlations were found between the degree of morphological alterations and Al intake up to 2.5 kg (p = 0.0003), as well as for morphology and duration of longterm HD up to 178 months (p = 0.001). Most sensitive structure for CNS deposits were choroid epithelia, followed by glial cells and neurons. Autonomic ganglia, heart, ovary/testis, parathyroid, adrenal, and pituitary demonstrated reliably peripheral deposits. Al-containing drugs, administered preferentially during HD, explain the additional significance of Al uptake and duration of dialysis (R-Qu. = 0.6697). The deposition of Al-containing proteinaceous inclusions is apparently irreversible. After renal transplantation, with termination of drug-related Al intake and normalized renal Al excretion, the Al-induced argyrophilic degradation products remained in the cellular cytoplasm in unchanged fashion up to 10 years.