Ann Occup Environ Med.  2016 ;28(1):35. 10.1186/s40557-016-0118-z.

IgA nephropathy in a laboratory worker that progressed to end-stage renal disease: a case report

• Min B
• Kim G
• Kang T
• Yoon C
• Cho SI
• Paek D

• KMID: 2370915
• DOI: http://doi.org/10.1186/s40557-016-0118-z

Abstract

BACKGROUND
IgA nephropathy (IgAN) is the most common form of glomerulonephritis, a principal cause of end-stage renal disease (ESRD) worldwide. The mechanisms of onset and progression of IgAN have not been fully revealed, and epidemiologic studies have yielded diverging opinions as to the role of occupational exposure to organic solvents in the initiation or worsening of IgAN. As the authors encountered a laboratory worker with IgAN that progressed to ESRD, we present a case report of IgAN progression due to dichloromethane exposure along with a review of literature.
CASE PRESENTATION
A 41-year-old male laboratory worker began to experience gross painless hematuria after two years of occupational exposure to toluene. Although clinical follow-up was initiated under the impression of IgAN based on clinical findings, the patient continued to work for four more years in the same laboratory, during which he was in charge of laboratory analysis with direct exposure to a high concentration of dichloromethane without proper protective equipment. During that time, his renal function rapidly worsened and finally progressed to ESRD 10 years after the first clinical symptoms. The result of exposure assessment through reenactment of his work exceeded the occupational exposure limit for dichloromethane to a considerable degree.
CONCLUSIONS
The causal association between occupational solvent exposure and IgAN is still unclear; therefore, this case report could be used as a basis to support the relevance of occupational solvent exposure to IgAN and/or its progression. Early intervention as well as close monitoring of laboratory workers exposed to various organic solvents is important to prevent or delay the progression of glomerulonephritis to ESRD in the occupational setting.

Keyword

Keywords; IgA nephropathy; End-stage renal disease; Organic solvent; Occupational exposure; Laboratory worker; Toluene; Dichloromethane

MeSH Terms

Adult
Early Intervention (Education)
Epidemiologic Studies
Follow-Up Studies
Glomerulonephritis
Glomerulonephritis, IGA*
Hematuria
Humans
Immunoglobulin A*
Kidney Failure, Chronic*
Male
Methylene Chloride
Occupational Exposure
Solvents
Toluene
Immunoglobulin A
Methylene Chloride
Solvents
Toluene