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Exposure to environmental pollutants may impact kidney health
Evidence indicates polyfluoroalkyl substances may be an environmental threat to kidney health, although research needs to be done to understand and address these effects, according to a press release.
“The key take home for me is that [polyfluoroalkyl substances] PFAS are a globally ubiquitous pollutant with high human exposure and concerning chemical properties that appear to be able to cause kidney disease through several different mechanisms; yet, we know almost nothing about long-term kidney health outcomes, who is at greatest risk for adverse outcomes or which communities may be most negatively impacted,” study co-author John W. Stanifer, MD, told Healio.com/Nephrology.
Stanifer and colleagues searched PubMed, EMBASE, EBSCO Global Health, the WHO Global Index and Web of Science for studies published between 1990 and 2018 that included epidemiology, pharmacokinetics or toxicology of polyfluoroalkyl substances (PFAS) exposure and kidney-related health, or results related to the pharmacokinetic role of the kidneys.
Investigators found a total of 74 studies, of which 21 were epidemiologic; 13 were pharmacokinetic; and 40 were toxicological studies. Results showed three population-based epidemiologic studies found PFAs exposure correlated with lower kidney function. Toxicology studies, which showed tubular histologic and cellular changes from PFAS exposure, and pharmacokinetic studies showed kidneys were major elimination routes with proximal tubule transport. PFAS exposure in 17 studies had changed some pathways linked to kidney disease. These included oxidative stress pathways, peroxisome proliferators-activated receptor pathways, NF-E2–related factor 2 pathways, partial epithelial mesenchymal transition and enhanced endothelial permeability through actin filament modeling.
“It is also concerning to me that children and adolescents have the highest exposure; yet, the long-term consequences are completely unknown and life-course epidemiology studies are much needed,” Stanifer said. “Finally, in the context of kidney disease, these are like so many other environmental toxins in that we don’t know how they interact to worsen or augment kidney disease in people with other risk factors such as diabetes or hypertension.”– by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.
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Stanifer JW, et al. Clin J Am Soc Nephrol.2018;doi:10.2215/CJN.04670418.