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50 Ins. Counsel J. 146 (1983)
Tetrachloroethylene: A Cause of Permanent Kidney Damage

handle is hein.journals/defcon50 and id is 148 raw text is: INSURANCE COUNSEL JOURNAL - January, 1983 Tetrachloroethylene: A Cause Of Permanent Kidney Damaget NATHANIEL SHAFER, M.D., D.I.M., F.C.C.P.* AND ROBERT SHAFER, M.D.** Editor's Note: The senior author of this article is a prolific medical writer and for- mer editor of Medical Counterpart. Indus- trial and environmental diseases due to ex- posure have become a way of life that will not go away-undoubtedly become more of a problem, certainly not less. Tetrachloro- ethylene (perchloroethylene) is one of these compounds. Its involvement in cancer, not only of those exposed but their offspring, has been strongly suggested by investiga- tors. This article is an excellent introduc- tion to this subject. Introduction In this past decade, most health care pro- fessions have become acutely aware of the health hazards in our environment. Exces- sive exposure to various metallic elements has been found to cause numerous nephro- toxic syndromes. Gold (Biblio No. 1), bismuth (Biblio No. 2) and mercury (Bib- lio No. 3) have been direct causes of the nephrotic syndrome, presumably through an immune complex mechanism (Biblio No. 4). Other heavy metals, chemicals and chemical compounds are now associated with an interstitial nephritis and structural and functional tubular abnormalities re- sembling the Fanconi syndrome (Biblio Nos. 5-10). Certain occupations present a specific hazard to the people engaged in them and the study of the medical aspects of these hazards has given rise to the specialty of industrial medicine. Only recently has the vast magnitude of toxic chemicals em- ployed in industry become apparent. tReprinted with permission from Medical Trial Technique Quarterly (pp. 387-395, 1982) edited by Fred Lane, published by Callaghan & Co., 3201 Old Glenview, Wilmette, Illinois 60091. 010 East 85th Street, New York, New York 10028. In private practice of Internal Medicine; Assistant in Medicine, New York Medical College Faculty, Albert Einstein College of Medicine. **Medical student, New York University, College of Medicine. The assistance of Marc Wilkenfeld in the prep- aration of this article is acknowledged. Even with this recent increase of interest in industrial hazards, many physicians still forget to include occupational exposure to chemicals in their differential diagnosis (Biblio Nos. 2, 3). They assume that safe- ty measures are enforced, such as proper labeling, control of concentrations in the atmosphere, etc. (Biblio No. 1). This is often not the case. It is important to real- ize that the etiology will be revealed only when the physician considers the possibil- ity; the patient and those about him rarely, if ever, connect an illness with the inhala- tion of toxic solutions. Thus, it is essential for the physician to know the special clini- cal features of these nephropathies. Tetrachloroethylene Tetrachloroethylene (perchloroethylene) is a colorless, volatile liquid which has been.widely used as an inhalation anesthet- ic (Trilene) for many years. Its other ma- jor applications include use in industry as a degreasing and extracting agent, as a sol- vent for dry cleaning and textile work and as a vehicle for rubber and plastic cements. Workers chronically exposed to this sub- stance have been known to develop hepa- titis, renal failure, myocarditis, cranial nerve palsies and a variety of personality and systemic symptoms as well as habitua- tion (Biblio Nos. 1, 2). While hepatic necrosis is the major seri- ous toxicity thus far reported, renal failure is a definite consequence of perchloroethy- lene poisoning (Biblio Nos. 3, 11-20). This fact is accentuated by a study performed in the Department of Medicine at George- town University School of Medicine (Biblio No. 18), where one patient had a clinical course closely resembling CC14 poisoning. The patient's only exposure to toxic ma- terials was to a large open container of tetrachloroethylene used for removing grease from gun parts. Only infrequently have instances of liver abnormality and occasional reversible cardiac arrhythmias been reported with limited clinical use or exposure. In the past, this was accepted as Page 146

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