The enigma of aluminum deposition in bone tissue from a patient with chronic kidney disease: a case report / O enigma da deposição de alumínio no tecido ósseo de um paciente com doença renal crônica: relato de caso

ABSTRACT About four decades ago, the relationship between dialysis-dementia and aluminum (Al) began to be established. The restriction of drugs containing Al and improvements on water quality used for dialysis resulted in the clinical disappearance of Al intoxication. However, high prevalence of Al deposition in bone tissue from Brazilian dialysis patients is still being detected. Through the case report of a patient on hemodialysis (HD) for one year, presenting significant Al deposition in bone tissue, we speculated if this problem is not being underestimated. We used extensive investigation to identify potential sources of Al exposure with a careful review of medication history and water quality controls. Al concentration was measured by different methods, including mass spectrometry, in poly-electrolyte concentrate solutions and solution for peritoneal dialysis, in an attempt to elucidate the possible sources of contamination. The objective of this case report is to alert the medical community about a potential high prevalence of Al deposition in bone tissue and to discuss the possible sources of contamination in patients with chronic kidney disease (CKD).

RESUMO Cerca de quatro décadas atrás, a relação entre demência relacionada à diálise e alumínio (Al) começou a ser estabelecida. A restrição de medicamentos contendo Al e melhorias na qualidade da água utilizada na diálise resultaram no desaparecimento clínico da intoxicação por Al. Contudo, no Brasil continua a ser identificada uma elevada prevalência de deposição de Al no tecido ósseo de pacientes em diálise. O presente relato de caso de um paciente em hemodiálise (HD) há um ano com deposição significativa de Al no tecido ósseo nos leva a especular se esse problema não tem sido subestimado. Realizamos uma ampla investigação para identificar possíveis fontes de exposição ao Al, com uma revisão cuidadosa do histórico de medicação e dos controles de qualidade da água. A concentração de Al foi medida por diferentes métodos, incluindo espectrometria de massa, nos concentrados polieletrolíticos para hemodiálise e soluções de diálise peritoneal, na tentativa de elucidar as possíveis fontes de contaminação. O objetivo do presente relato de caso é alertar a comunidade médica sobre uma possível elevada prevalência de deposição de Al no tecido ósseo e discutir as possíveis fontes de contaminação nos pacientes com doença renal crônica (DRC).

Accumulation, tolerance and impact of aluminium, copper and zinc on growth and nitrate reductase activity of Ceratophyllum demersum (Hornwort).

Ceratophyllum demersum (homwort) was subjected to toxic concentrations of Al (3 and 9 mg l(-1)), Zn (3 and 9 mg l(-1)) and Cu (2.5 and 7 mg l(-1)) in culture solutions for 15 days. The higher dose of Al enhanced the chlorophyll content significantly (p<0.05) in the first 6 days of treatment while other treatments caused marked reductions. Nitrate reductase activity (NRA) was significantly reduced (p<0.05) byAl, Cu and Zn toxicity and ceased completely in plants treated with Cu by the 6th day of treatment. Dry biomass and relative growth rate were reduced significantly (p<0.05) by metal treatment. Tolerance index of the plant was low for Cu (21.62 and 13.43% at low and high doses, respectively) and moderate for Zn (63.74 and 54.85%) and Al (72.83 and 68.79%). Accumulation ofAl, Zn and Cu was threefold at higher doses compared with the lower doses but the bioconcentration factors (BCF) were very low indicating that this plant is not a hyper accumulator of these metals.

A geographic information system (GIS) analysis for trace metal assessment of sediments in the Gulf of Paria, Trinidad

The Gulf of Paria is a semi-enclosed shallow basin with increasing coastal development activities along Trinidad's west coast. Sediments present a host for trace metal pollutants from overlying waters, therefore determination of their content is critical in evaluating and detecting sources of marine pollution. This paper presents a Geographic Information System (GIS) analysis of geochemical assessment for trace metals in coastal sediments of the Gulf of Paria. This GIS approach facilitates interpretation of the spatial relationships among key environmental processes. The GIS development involves the integration of spatial and attribute data pertaining to bathymetry, current systems, topography, rivers, land use/land cover and coastal sediments. It employs spatial interpolation and retrieval operations to analyze the total trace metal concentrations of aluminum, copper and lead in the sediments and the clay-enriched sediments, to determine whether they are related to sediment type or are affected by the discharge from anthropogenic sources. Spatial distribution modeling of element concentrations are produced to indicate contamination plumes from possible anthropogenic sources such as rivers entering the Gulf of Paria, and to reveal potential hot spots and dispersion patterns. A direct spatial correlation between clay-enriched sediments and high concentrations of aluminum and lead is detected, however regions of high concentrations of copper and lead indicate a relationship to anthropogenic sources. The effectiveness of GIS for visualization, spatial query and overlay of geochemical analysis is demonstrated.

Histochemical staining of bone aluminum: comparison of aluminon and acid solochrome azurine and their correlation with bone aluminum content

O aluminio (Al) pode ser um dos fatores patogenicos envolvidos na doença ossea de pacientes uremicos. Os corantes Aluminon (Acido Tricarboxilico aurico) e Acido Solocromo Azurina, tem sido utilizados para detectar depositos de aluminio no tecido osseo. Utilizamos um modelo experimental de intoxicaçäo aluminica em ratos normais (N) e uremicos (U) e comparamos a sensibilidade dos dois corantes na detecçäo do aluminio. Os grupos receberam injeçöes intraperitoniais de Cloreto de Aluminio (AlCl3), ate uma dose cumulativa de 5 mg (NAL5; UAL5) e 30 mg (NAL30; UAL30). Os grupos controles receberam injeçöes intraperitoniais de agua destilada...

Aluminum ingestion alters behaviour and some neurochemicals in rats.

Effect of aluminum (Al) has been investigated on the brain of rats exposed to this metal (500 mg Al/liter in drinking water) daily for 180 days. A significant reduction in the spontaneous locomotor activity was noticed after 90 and 180 days of Al exposure to the rats, the magnitude of the change being almost identical at both the time intervals. Aluminum exposure also produced significant deficits in acquisition and retention of learned response in active avoidance situation, these changes being time dependent. A significant retardation of the extinction of the learned task was noted in Al exposed rats especially at 180 days. There was significant increase in the lipid peroxidation and decrease in the activity of Mg(2+)-ATPase and Na+,K(+)-ATPase in the brain of rats at 180 days after Al exposure. The increase in the contents of the metal was maximum in rest of the brain region (87% of control) followed by hippocampus and cerebral cortex (59% of controls), cerebellum and corpus striatum (43% and 44% of controls, respectively) after 180 days. Whether Al is responsible to initiate neurotoxic effects by producing changes in the structure and function of the plasma membrane needs further investigations.