Aluminum and renal failure

Increasing the accumulation of aluminum in the bone (body) in cases of renal osteodystrophy may influence the histopathologic aspect of the bones. Alumi num blunts the effect of increased PTH secretion and favours the genesis of osteoid. That means, in cases of renal failure combined with aluminum accumulation, a relatively low bone tunover is found and no fibrosis of the bone marrow. Furthermore the amount of osteoid is increased. This means that there is evidence of osteomalacia especially when the latter is defined as an increased amount of osteoid covered with a relatively low number of cubic osteoblasts. To a certain extent the effect of aluminum accumulation is comparable to the effect of PTX. Treatment with DFO may normalize the bone, although not necessarily with a concomittant disappearance of alumi num from the bone. The presence of aluminum in the bone can be suggested by routine histologic investigation of the bone and can be made rather probably by the aluminum staining combined with iron-staining, but can only be proven by more advanced techniques like ET AAS and LAMMA. References 1. Boyce BF, Elder HY, Elliot HL, Fogelman I, Gell GS, lunor Bl, Beastall G, Boyle YT, 1982: Hypercaicaemic ostemalacia due to aluminium toxicity. Lancet 6: 1009. 2. Verbueken AH, Visser Wl, Van de Vyver FL, Van Grieken RE, De Broe ME, 1986: The use of laser microprobe mass analysis (LAMMA) to control the staining of aluminum by aurin tricarboxylate (aluminon). Stain Technology 61: 287.

Zusammenfassung
` ... the material presented provides valuable information concerning the biological effects and clinical syndromes associated with aluminum exposure. This volume should be useful for students and nephrologists who are interested in furthering their understanding of the area.'
Dialysis and Transplantation, 20/1, January 1991

Inhalt
General.- Historical survey of aluminum-related diseases.- Chemistry of aluminum.- The metabolism of aluminum.- Intestinal absorption of aluminum.- Aluminum determination in biological samples.- Quality control of aluminum measurements.- Pathophysiology.- Pathophysiologic mechanisms of aluminum toxicity: Aluminum-induced bone disease.- Aluminum encephalopathy: Experimental vs human.- Alzheimer's disease: Aluminum and fibrinous proteins.- Aluminum interaction with macromolecules and membranes.- Cellular and subcellular localization of aluminum: Histochemistry.- Cellular and subcellular localization of aluminum.- Experimental models of aluminum toxicity.- Clinical.- Sources of aluminum.- Unusual sources of aluminum.- Experimental aluminum induced bone disease.- Aluminum induced bone disease: Clinical features.- Aluminum induced bone disease: Histology.- Dialysis encephalopathy.- Other clinical syndromes associated with aluminum. Microcytic anemia, joint pain, severe infections, liver dysfunction.- Aluminum toxicity in childhood.- Occupational exposure to aluminum and its compounds and their health effects.- Diagnosis.- The Diagnosis of aluminum toxicity.- Treatment.- Deferoxamine therapy of aluminum toxicity in dialysis patients.- Alternative phosphate binders for aluminum hydroxide.- Risk factors for aluminum toxicity and its prevention.- Index of subjects.