Analgesics use and ESRD in younger age: a case-control study

<p>Abstract</p> <p>Background</p> <p>An ad hoc peer-review committee was jointly appointed by Drug Authorities and Industry in Germany, Austria and Switzerland in 1999/2000 to review the evidence for a causal relation between phenacetin-free analgesics and nephropathy. The committee found the evidence as inconclusive and requested a new case-control study of adequate design.</p> <p>Methods</p> <p>We performed a population-based case-control study with incident cases of end-stage renal disease (ESRD) under the age of 50 years and four age and sex-matched neighborhood controls in 170 dialysis centers (153 in Germany, and 17 in Austria) from January 1, 2001 to December 31, 2004. Data on lifetime medical history, risk factors, treatment, job exposure and intake of analgesics were obtained in a standardized face-to-face interview using memory aids to enhance accuracy. Study design, study performance, analysis plan, and study report were approved by an independent international advisory committee and by the Drug Authorities involved. Unconditional logistic regression analyses were performed.</p> <p>Results</p> <p>The analysis included 907 cases and 3,622 controls who had never used phenacetin-containing analgesics in their lifetime. The use of high cumulative lifetime dose (3^rdtertile) of analgesics in the period up to five years before dialysis was not associated with later ESRD. Adjusted odds ratios with 95% confidence intervals were 0.8 (0.7 – 1.0) and 1.0 (0.8 – 1.3) for ever- compared with no or low use and high use compared with low use, respectively. The same results were found for all analgesics and for mono-, and combination preparations with and without caffeine. No increased risk was shown in analyses stratifying for dose and duration. Dose-response analyses showed that analgesic use was not associated with an increased risk for ESRD up to 3.5 kg cumulative lifetime dose (98 % of the cases with ESRD). While the large subgroup of users with a lifetime dose up to 0.5 kg (278 cases and 1365 controls) showed a significantly decreased risk, a tiny subgroup of extreme users with over 3.5 kg lifetime use (19 cases and 11 controls) showed a significant risk increase. The detailed evaluation of 22 cases and 19 controls with over 2.5 kg lifetime use recommended by the regulatory advisors showed an impressive excess of other conditions than analgesics triggering the evolution of ESRD in cases compared with controls.</p> <p>Conclusion</p> <p>We found no clinically meaningful evidence for an increased risk of ESRD associated with use of phenacetin-free analgesics in single or combined formulation. The apparent risk increase shown in a small subgroup with extreme lifetime dose of analgesics is most likely an indirect, non-causal association. This hypothesis, however, cannot be confirmed or refuted within our case-control study. Overall, our results lend support to the mounting evidence that phenacetin-free analgesics do not induce ESRD and that the notion of "analgesic nephropathy" needs to be re-evaluated.</p

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

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

Västberga Artistkollektiv

Västberga Artistkolletiv (VAK), as a project, is an investigation into the self-image of my home town, Stockholm. It is a mapping of both the experienced and factual cultural scene in order to understand how and where an addition would be suitable. The end goal has been a physical building, a platform that strategically helps raising the creative potential of this city. The idea is to design a place dedicated to creating the best possible environment for recording live concerts, in regard to both audio and video. Hence, an acoustically perfected live venue for broadcasting and recording artists of various levels. The purpose is to provide a platform where they can grow, as well as spread their music and art. Furthermore, it is a meeting point for people, so experiencing a concert on site should not be regarded as less of a priority than the recorded material. On the larger scale the investigation aims to establish the link between the architecture - the venue, and the self-image of the city and its citizens, to see how they are nurturing each other. This is also a residential building, and a gathering spot for anyone that feels like they want to be a part of a creative environment, living inside a concert venue, while working on their own music or collaborating with the platform and radio station

The Ship's Bridge Market

Mitt projekt bygger på den traditionella saluhallen med ljus ovanifrån. Tunga väggar av tegel och en hög takhöjd skapar en upplevelse som förknippas med en myllrande marknadsplats. Samtidigt bidrar det böjda taket av trä till att lätta upp den strikta formen. I taket ligger dessutom ett lager akustikdämpning som förhindrar att ljudnivån blir för hög, vilket annars är en risk i det stora rummet och de hårda väggytorna. Den centrala gången framhävs genom en ökad rymd. Byggnaden tar upp stor plats längst kajen, men är tänkt som en förlängning av gatan med sina breda entréer. Platsen på Skeppsbron tillåter ett stort tillägg och är tvärtom i behov av en destination. Byggnaden är framför allt planerad i ett plan för att minska takhöjden och inte bryta siktlinjerna från intilliggande hus och kajkanten. Där Tullhus 3 tidigare endast lämnade en smal gång för fotgängare och cyklister finns nu en bred väg under tak.    Marknaden är mestadels introvert för att skapa rummet där allt händer på en gång. Fisk säljs över disk samtidigt som restaurangen med det öppna köket ligger några meter därifrån. Under sommaren, då borden flyttats ut i solen, kan man cykla hela vägen fram till fiskdisken. Mot vägen, i västlig riktning, ligger marknadens egna renseri där de passerande kan följa fiskhanteringen, och på så sett se den gå från nyfångad till tillagad. Från kontorets balkong bevittnas hela spektaklet.  My project is built on the traditional hall with light from above. Heavy brick walls and a raised ceiling create the feeling associated with a crowded marketplace. At the same time, the flowing wooden ceiling loosens the strict boundaries. Furthermore, the ceiling contains a layer of acoustic absorbers with the purpose of restraining the level of noise in the hall. The central walkway is highlighted through an increased volume and raised ceiling. The Ship’s Bridge is in need of a destination, hence the markets big impact on the site. However, the passing pedestrians and cyclists are now reserved a wider passage than before. The Ship’s Bridge Market is an introvert building to promote the meeting place where everything happens at once. Fish is being sold over the counters while the restaurant, with its open kitchen, is just a few steps away. During the summer, when the tables has been moved outside, you can bring your bike all the way in. The fish is being delivered and handled and from the office on the second floor you are able to watch the entire spectacle

Risk factors for the development of chronic renal failure : Epidemiological studies on the role of analgesic use, occupational exposures and socioeconomic background

Chronic renal failure is a severe condition that reduces life expectancy and typically progresses to end-stage renal disease and a need for renal replacement therapy. In a large proportion of cases, chronic renal failure evolves from known renal or systemic diseases, but in some cases the pathogenesis remains unknown. The aim of this thesis was to investigate whether the use of paracetamol and aspirin, occupation and workplace exposures, and socioeconomic status affect the development of chronic renal failure. We conducted a nation-wide population-based case-control study in Sweden. All 5.3 million native-born residents aged 18 to 74 years, living in the country during the period from May, 1996, through May, 1998, formed the study base. Personal interviews were performed with 926 patients with incident pre-uraemic chronic renal failure and 928 randomly selected control subjects. Regular use of either paracetamol or aspirin in the absence of the other was associated with a significant increase by a factor of 2.5 in the risk of chronic renal failure from any cause. The relative risks rose with increasing cumulative lifetime doses, and were increased for most disease-specific types of chronic renal failure. The associations were only slightly attenuated when the recent use of analgesics, which could have occurred in response to antecedents of renal disease, was disregarded. Our results are consistent with the existence of exacerbating effects of paracetamol and aspirin on chronic renal failure. Low socio-economic status was associated with an increased risk of chronic renal failure. In families with unskilled workers only, the risk of chronic renal failure was increased by 110% and 60% among women and men, respectively, relative to subjects living in families in which at least one member was a professional. Subjects with 9 years or less of schooling had a 30% higher risk compared with those with a university education. The excess risk was of similar magnitude regardless of underlying renal disease. The moderate excess was not explained by age, sex, body mass index, smoking, alcohol or analgesic intake. Thus, socioeconomic status appeared to be an independent risk indicator for chronic renal failure in Sweden. Our results did not support the hypothesis of an adverse effect of organic solvents on chronic renal failure development, in general. The overall risk for chronic renal failure among subjects ever exposed to organic solvents was virtually identical to that among never-exposed (odds ratio, 1.01; 95% Cl, 0.81-1.25). No dose-response relationships were observed for lifetime cumulative solvent exposure, average dose, or exposure frequency or duration. The absence of association pertained to all subgroups of chronic renal failure. Detrimental effects from subclasses of solvents or on specific renal diseases cannot be ruled out. Except for organic solvents and exhaust fumes, which were unrelated to risk of chronic renal failure, the exposure prevalence were low to the workplace exposure agents implicated in the literature. Silica and cadmium were associated with 39% (95% Cl, 0-94%) and 26% (95% Cl, -55-67%) excess risks, respectively, but apart from this, no striking excesses were found. There was an up to 2-fold variation in risk for chronic renal failure across occupational groups. This significant heterogeneity (P=0.001) in chronic renal failure risk among occupational groups could not be explained by studied lifestyle factors or workplace exposures