The diagnosis of aluminium toxicity

  • Jorge B Cannata Andia
  • Jose B Diaz Lopez
Part of the Developments in Nephrology book series (DINE, volume 26)


In this chapter we shall describe what should alert us to suspect aluminium toxicity and the useful tools we gather today to confirm this diagnosis. As the first step is to suspect aluminium toxicity, our attention should be drawn to investigate mainly the role of dialysis fluids and oral aluminium intake. As a general rule, a long-term management of renal patients should be always suspicious of long-term aluminium exposure.

Although till recently, nephrologists assessed aluminium toxicity only in symptomatic patients, a great percentage of renal patients could have alumi-nium accumulation without clear cut symptoms and therefore the present trend is to perform a more ample screening. The current clinical findings useful to suspect aluminium toxicity are the presence of bone disease, central nervous system disorders and worsening of the anaemia, nevertheless, all these manifestations can be considered late indicators of aluminium accumulation.

The non-invasive methods play an important role in the suspicion and also in the diagnosis of aluminium toxicity. The presence of hypercalcaemia together with inadequately low parathyroid hormone levels must be carefully evaluated as they constitute a very frequent pattern of aluminium toxicity. The radiological findings and the different types of bone scans can be also valuable and complementary studies, but never by themselves can confirm the diagnosis.

Serum aluminium levels are indeed higher in patients with proved alumi-nium toxicity. However, they have a limited value in the diagnosis of alumi-nium accumulation, being particularly useful as an index of acute aluminium exposure. In addition, baseline serum aluminium levels frequently correlate with bone aluminium but they are not a reliable predictor of aluminium-induced bone disease.

The desferrioxamine test has also some limitations, however, it could give a more accurate information about aluminium body stores and it has a particular value in excluding the diagnosis of aluminium related bone disease.

In the diagnosis of aluminium toxicity none of the clinical and biological features described previously are neither specific nor essential. In fact, a conclusive proof of aluminium toxicity in human would require the demon-stration of aluminium accumulation in a given organ. To date, of the three target systems described as affected in aluminium toxicity, only bone is available and fulfill enough criteria to make a diagnosis.

As stainable bone aluminium correlates with aluminium bone content and because its localisation at the osteoid/calcified bone interface has a great value in predicting bone histology, it is always necessary to perform histochemical staining and histomorphometrical studies of bone biopsy specimens to make a more precise diagnosis of aluminium-induced bone disease.


Aluminium Toxicity Renal Patient Serum Aluminium Aluminium Exposure Aluminium Accumulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kerr DNS, Ward MK, 1986: The history of aluminium related disease. In: Aluminium and other trace elements in renal disease. Ed: A Taylor, Balliere Tindall, London, 1–14.Google Scholar
  2. 2.
    Bertran HP, Kemper FH, Miiller C, Winterberg B, Zumkley H, 1985: Aluminium, copper, zinc and iron contents in blood, plasma, bone and hair of dialysis patients with renal insufficiency. Trace Elem Med 2: 104.Google Scholar
  3. 3.
    Gitelman H, Alderman FR, 1986: Electrothermal determination of aluminium in biological samples by atomic absorption spectroscopy. Kidney Int 29: (suppl 18) S28.Google Scholar
  4. 4.
    De Broe ME, Van de Vyver FL, Silva FJ, D’Hase P, Verbueken H, 1986: Measuring aluminium in serum and tissues. Overview and perspectives. Nefrologia 6: (suppl 1) S41.Google Scholar
  5. 5.
    Savory J, Wills M, 1986: Analytical methods for aluminum measurement. Kidney Int 29: (suppl 18) S24.Google Scholar
  6. 6.
    Hem JD, 1986: Geochemistry and aqueous chemistry of aluminum. Kidney Int 29: (suppl 18) S3.Google Scholar
  7. 7.
    Trapp G, 1986: Interactions of aluminium with cofactors, enzymes and other proteins. Kidney Int 29: (suppl 18) S12.Google Scholar
  8. 8.
    Siegel N, 1986: Aluminum interaction with biomolecules: The molecular basis for aluminium toxicity. Am J Kidney Dis 6: 353.Google Scholar
  9. 9.
    Alfrey AC, Legendre GR, Kaheny WD, 1976: The dialysis encephalopathy syndrome. Possible aluminium intoxication. N Engl J Med 294: 184.PubMedCrossRefGoogle Scholar
  10. 10.
    Elliot HL, MacDougall AL, Fell GS, 1978: Aluminium toxicity syndrome. Lancet 1: 1203.CrossRefGoogle Scholar
  11. 11.
    Mayor GH, Keiser JA, Paok K, 1977: Aluminium absorption and distribution: Effect of parathyroid hormone. Science 197: 1187.PubMedCrossRefGoogle Scholar
  12. 12.
    Ward MK, Feest TG, Ellis HA, Parkinson I, Kerr DNS, Herrington J, Goode GL, 1978: Osteomalacic dialysis osteodystrophy: evidence for a water borne aetiological agent, prob¬ably aluminium. Lancet 1: 841.PubMedCrossRefGoogle Scholar
  13. 13.
    Alfrey AC, Hegg BS, Craswell P, 1980: Metabolism and toxicity of aluminium in renal failure. Am J Nutr 33: 1509.Google Scholar
  14. 14.
    O’Hare JA, Murnaghan DJ, 1982: Reversal of aluminium-induced haemodialysis anaemia by a low-aluminium dialysate. N Engl J Med 306: 654.PubMedCrossRefGoogle Scholar
  15. 15.
    Cannata JB, Briggs JD, Junor BJR, Fell GS, Beastall G, 1983: Effect of acute aluminium overload on calcium and parathyroid-hormone metabolism. Lancet 1: 501.PubMedCrossRefGoogle Scholar
  16. 16.
    Wills MR, Savory S, 1983: Aluminium poisoning: dialysis encephalopathy, osteomalacia, and anaemia. Lancet 2: 29.PubMedCrossRefGoogle Scholar
  17. 17.
    Touam M, Martinez F, Lacour B, Bourdon R, Zingraf J, Di Giulio S, Drueke T, 1983: Aluminium-induced reversible microcytic anaemia in chronic renal failure: Clinical and experimental studies. Clin Nephrol 19: 295.PubMedGoogle Scholar
  18. 18.
    Robertson J, Felsenfeld A, Haygood C, Llach F, 1983: An animal model of aluminium induced osteomalacia: Role of chronic renal failure and parathyroid hormone. Kidney Int 23: 327.PubMedCrossRefGoogle Scholar
  19. 19.
    Goodman WG, Henry DA, Horst R, Hudelman RK, Alfrey AC, Coburn JW, 1984: Parenteral aluminium administration in the dog. Induction of osteomalacia and effect on vitamin D metabolism. Kidney Int 25: 370.PubMedCrossRefGoogle Scholar
  20. 20.
    Rahman H, Channon SM, Skillen, Ward M, Kerr DNS, 1984: Protein binding of aluminium in normal subjects and in patients with chronic renal failure. Proc Eur Dial Transplant Assoc 21: 260.Google Scholar
  21. 21.
    Cannata JB, Suarez Suarez C, Cuesta MV, Rodriguez Rosa R, Allende MT, Herrera J, Perez Llanderal J, 1984: Gastrointestinal aluminium absorption: Is it modulated by the iron absorptive mechanism? Proc Eur Dial Transplant Assoc 21: 354.Google Scholar
  22. 22.
    Alfrey AC, Sedman A, Chan YL, 1985: The compartmentalization and metabolism of aluminium in uraemic rats. J Lab Clin Med 25: 227.Google Scholar
  23. 23.
    Simon P, Allain P, Ang KS, Cam G, Mauras Y, 1984: Prophylaxie et traitment de l’intoxication aluminique chez l’insuffisant renal chronique. In Actualités Néphrologiques de 1’ Hôpital Necker, Flammarion Médicine Sciences, pp. 383–414.Google Scholar
  24. 24.
    Kerr DNS, Ward M, Arze R, Ramos M, Grekas D, Parkinson I, Ellis H, Owen P, Simpson W, Dewar J, Martin A, Me Hugh M, 1986: Aluminium induced osteodystrophy: The demise of ‘Newcastle bone disease’. Kidney Int 29 (suppl 18) S58.Google Scholar
  25. 25.
    Malluche HH, Faugere MC, Smith AJ, Friedler RM, 1986: Aluminium intoxication of bone in renal failure: Fact or fiction? Kidney Int 29: (suppl 18) S70.Google Scholar
  26. 26.
    Cournot-Witmer G, Placot JJ, Bordeau A, Lieberherr M, Jorgetti V, Mendes V, Halpern S, Hemmerle J, Drueke T, Balsan S, 1986: Effect of aluminium on bone and cell localization. Kidney Int 29 (suppl 18) S37.Google Scholar
  27. 27.
    Llach F, Felsenfeld A, Coleman MD, Keveny J, Pederson JA, Medlock R, 1986: The natural course of dialysis osteomalacia. Kidney Int 29: (suppl 18) S74.Google Scholar
  28. 28.
    Cannata JB, Diaz Lôpez B, Fernandez Menendez MJ, Virgôs MJ, 1988: The parathyroid gland and aluminium overload: An overview. In: Bone in renal failure. Contr Nephrol 64: Ed. ME de Broe, Karger Basel, 113–119.Google Scholar
  29. 29.
    Berlyne GM, Ben Ari J, Pest DL, Weinberger J, Stern M, Gilmore GR, Levine R, 1970: Hyperaluminaemia from aluminium resins in renal failure. Lancet 2: 494.PubMedCrossRefGoogle Scholar
  30. 30.
    Kaheny WD, Hegg AP, Alfrey AC, 1977: Gastrointestinal absorption of aluminium from aluminium-containing antacids. N Engl J Med 286: 1937.Google Scholar
  31. 31.
    Klein GL, Alfrey AC, Miller NL, 1982: Aluminium loading during parenteral nutrition. Am J Clin Nutr 35: 1425.Google Scholar
  32. 32.
    Cannata JB, Briggs JD, Junor BJR, Fell GS, 1983: Aluminium hydroxide intake: a real risk of aluminium toxicity. Br Med J 286: 1937.CrossRefGoogle Scholar
  33. 33.
    Kaye M, 1983: Oral aluminium toxicity in a non-dialysed patient with renal failure. Clin Neprol 20: 208.Google Scholar
  34. 34.
    Andreoli SP, Bergstein JM, Sherrard DJ, 1984: Aluminium intoxication from aluminium containing phosphate binders in children with azotaemia not undergoing haemodialysis. N Engl J Med 310: 1079.PubMedCrossRefGoogle Scholar
  35. 35.
    Fell GS, Shenkin A, Hall DJ, 1986: Aluminium contamination of intravenous pharmaceuticals and blood products. Lancet 1: 380.CrossRefGoogle Scholar
  36. 36.
    Platts MM, Goode GC, Hislop GS, 1977: Composition of the domestic water supply and the incidence of fractures and encephalopathy in patients on home dialysis. Br Med J 2: 657.PubMedCrossRefGoogle Scholar
  37. 37.
    Kaheny WD, Alfrey AC, Holman RE, Schorr WJ, 1977: Aluminium transfer during haemodialysis. Kidney Int 12: 361.CrossRefGoogle Scholar
  38. 38.
    Elliot HL, Dryburgh F, Fell GS, Sabet S, Macdougall AL, 1978: Aluminium toxicity during regular haemodialysis. Br Med J 1: 1101.Google Scholar
  39. 39.
    Parkinson IS, Ward MK, Feest TG, Fawcet RW, Kerr DNS, 1979: Fracturing dialysis osteodystrophy and dialysis encephalopathy. An epidemiological survey. Lancet 1: 406.PubMedCrossRefGoogle Scholar
  40. 40.
    Graf H, Stummovoll HK, Meister V, Kovarik J, Wolf A, Pinggera W, 1981: Aluminium removal by haemodialysis. Kidney Int 19: 587.PubMedCrossRefGoogle Scholar
  41. 41.
    Davison AM, Walker GS, Oli H, Lewins AM, 1982: Water supply, aluminium concentration, dialysis dementia and effect of reverse-osmosis water treatment. Lancet 2: 785.PubMedCrossRefGoogle Scholar
  42. 42.
    Schreeder MT, Favero MS, Hughes JR, Petersen NJ, Bennet PH, Maynard JE, 1983: Dialysis encephalopathy and aluminium exposure: an epidemiological analysis. J Chron Dis 36: 581.PubMedCrossRefGoogle Scholar
  43. 43.
    Cross JR, 1986: Removing aluminium from water for haemodialysis. In: Aluminium and other trace elements in renal disease. Ed; A Taylor. Balliere Tindall, London, pp. 147 - 155.Google Scholar
  44. 44.
    Berlin A, Challah S, Seiwood NH, Mattiello G, Lai M, 1986: Prevention of aluminium exposure. Actions at European Community level. Nefrologia 6: (suppl 1)51.Google Scholar
  45. 45.
    Berlin A. Prevention and monitoring of aluminium exposure during dialysis in The Euro¬pean Community, 1986: In: Aluminium and other trace elements in renal disease. Ed; A Taylor, Balliere Tindall, London: pp. 167–170.Google Scholar
  46. 46.
    Boyce BF, Mocan MZ, Byars J, Halls DJ, Leung ACT, Burgoyne M, Junor BJR, 1986: Bone response in patients with aluminium related osteomalacia after desferrioxamine therapy and adequate water treatment. Nefrologia 6: (suppl 1) 109.Google Scholar
  47. 47.
    Cannata JB. Aluminium induced toxicity in dialysis patients, 1987: Role of water and other sources on its pathogenesis. In: Water treatment monograph. EDTNA-ERCA, Ed; F Lopot. (in press).Google Scholar
  48. 48.
    Drüeke T, Lacour B, 1984: L’apportt d’aluminium par voie digestive. In: Aluminium et insuffisance renale, Eds; T Drüeke, J Rottembourg. Gambro, Paris, 63 - 68.Google Scholar
  49. 49.
    Cannata JB, Suarez Suarez C, Rodriguez Suarez MC, Cuesta MV, Sanz Medel A, Peral V, Herrera J, 1984: Assessing the benefit of changing aluminium hydroxide schedule on anaemia and serum phosphorus control. Proc EDTA 21: 410.Google Scholar
  50. 50.
    Cannata JB, Diaz López B, Cuesta MV, Rodriguez Suarez C, Sanz-Medel A, 1985: Effect of 1.25 vitamin D treatment and iron stores on aluminium gastrointestinal absorption. In: Vitamin D Chemical, Biochemical and Clinical update, Springer-Verlag, New York: pp. 1145–1146.Google Scholar
  51. 51.
    Ihle B, Becker G, 1985: Gastrointestinal absorption of aluminium. Am J Kidney Dis 6: 302.PubMedGoogle Scholar
  52. 52.
    Cannata JB, T Drüeke, 1986: Absorción gastrointestinal de aluminio: Análisis de factoresGoogle Scholar
  53. implicados. Nefrologia 6: (suppl 1) 79.Google Scholar
  54. 53.
    Wills MR, Savory J, 1986: Aluminium homeostasis. In: Aluminium and other trace elements in renal failure. Ed; A Taylor, Balliere Tindall, London: pp. 24–37.Google Scholar
  55. 54.
    Alfrey AC, 1986: Aluminium metabolism. Kidney Int 29: (Suppl 18) S8.Google Scholar
  56. 55.
    Mocan MZ, Boyce BF, Briggs JD, Forwell M, Halls DJ, Junor BJR, 1986: Aluminium absorption in chronic renal failure. Nefrologia 6: (suppl 1) 87.Google Scholar
  57. 56.
    Cannata JB, Serrano M, Cuesta MV, Suarez Suarez C, Rodriguez Roza R, 1987: Reducing the oral aluminium exposure in renal patients. In: Proceeding of the Fifth International Capri Conference on uraemia. Ed; C Giordano, E Friedman. Lipincot, Naples, (in press).Google Scholar
  58. 57.
    Drüeke T, 1980: Dialysis Osteomalacia and aluminium intoxication. Nephron 26: 207.PubMedCrossRefGoogle Scholar
  59. 58.
    Hodsman AB, Sherrard DJ, Wong EGC, Brickman AS, Lee DBN, Alfrey AC, Singer FR, Norman AW, Coburn JW, 1981: Vitamin D resistant osteomalacia in hemodialysis patients lacking secondary hyperparathyroidism. Ann Intern Med 94: 629.PubMedGoogle Scholar
  60. 59.
    Boyce B, Fell GS, Elder HY, Junor BJR, Elliot HE, Beastall G, Fogelman I, Boyle IT, 1982: Hypercalcaemic osteomalacia due to aluminium toxicity. Lancet 2: 1009.PubMedCrossRefGoogle Scholar
  61. 60.
    Cannata JB, Briggs JD, Junor BJR, Beastall G, Fell GS, 1982: The influence of aluminium on calcium and parathyroid hormone metabolism in dialysed patients. Proc Eur Dial Transplant Assoc 19: 244.Google Scholar
  62. 61.
    Kerr DNS, Parkinson IS, Ward MK, Ellis HA, Bates BB, 1984: Epidemiological and clinical aspects of aluminium intoxication. Historical review. In: Aluminium et insuffisance rénale. Eds; T Drüeke, J Rottembourg, Gambro, Paris: pp. 149–158.Google Scholar
  63. 62.
    Cannata JB, Briggs JD, Junor BJR, 1984: Aluminium intoxication and PTH function: Clinical aspects. In: Aluminium et insuffisance rénale. Eds; T Drüeke et J Rottembourg, Gambro, Paris: pp. 227–238.Google Scholar
  64. 63.
    Mayor GH, 1985: The Case for Parathyroid Hormone. Am J Kidney Dis 6: 306.PubMedGoogle Scholar
  65. 64.
    Nebeker HG, Andress DL, Milliner DS, Ott SM, Alfrey AC, Slatopolsky EA, Sherrard DJ, Coburn JW, 1986: Indirect methods for the diagnosis of aluminum bone disease: plasma aluminum, the desferoxamine infusion test, and serum iPTH. Kidney Int 29: (suppl 18) S96.Google Scholar
  66. 65.
    Mazzuchi NP, Cannata JB, 1989: Prevención, diagnóstico y tratamiento de la intoxicación alumínica. Revisión y Perspectivas. Nefrologia 9: 15.Google Scholar
  67. 66.
    Arieff A, 1985: Aluminium and the pathogenesis of dialysis dementia. Am J Kidney Dis 6: 317.PubMedGoogle Scholar
  68. 67.
    Milne FJ, Sharf B, Bell P, Meyers AM, 1983: The effect of low aluminium water and desferrioxamine on the outcome of dialysis encephalopathy. Clin Nephrol 20: 202.PubMedGoogle Scholar
  69. 68.
    Alfrey AC, 1986: Dialysis encephalopathy. Kidney Int 29: (suppl 18) S53.Google Scholar
  70. 69.
    Cannata JB, Ruiz MP, Cuesta MV, Herrera J, Peral V, 1983: Influence of aluminium hydroxide intake on haemoglobin concentration and blood transfusion requirements in haemodialysis patients. Proc Eur Dial Transplant Assoc 20: 719.PubMedGoogle Scholar
  71. 70.
    Coburn JW, 1980: Renal osteodystrophy. Kidney Int 17: 677.PubMedCrossRefGoogle Scholar
  72. 71.
    Cassidy MJD, Owen JP, Ellis HA, Dewards J, Robinson CJ, Wilkinson R, Ward MK, Kerr DNS, 1985: Renal Osteodystrophy and metastatic calcification in long-term continuous ambulatory peritoneal dialysis. O J1 Med 54: 29.Google Scholar
  73. 72.
    Botella J, Gallego J, Fernández Fernández J, Sanz Guajardo D, de Miguel A, Ramos J, Franco P, Enriques R, Sanz Moreno C, 1984: The bone scan in patients with aluminium- induced bone disease. Proc Eur Dial Transplant Assoc 21: 403.Google Scholar
  74. 73.
    Karsenty G, Vigneron N, Jorgetti V, Fauchet M, Zingraf J, Drüeke T, Cournot-Witmer G, 1986: Value of the 99mTC methylendiphosphonate bone scan in renal osteodistrophy. Kidney Int 29: 1058.PubMedCrossRefGoogle Scholar
  75. 74.
    Herrera J, Cannata JB, Aira F, Cuesta MV, Allende MT, Peral V, Fernández Gudín M, Rodriguez R, 1985: Assessing the TC99m Methylendiphosphonate bone scan and its biological half-time as a non-invasive screening test for secondary hyperparathyroidism. In: Advances in Non-invasive Nephrology. Ed; G Lubec, V Campese, John Libbey, London: pp. 60–63.Google Scholar
  76. 75.
    Torres A, Moya M, 1982: A new method for the assessment of bone mass in renal osteodystrophy: Usefulness of computerized tomography scanning in haemodialysis patients. Nephron 30: 231.PubMedCrossRefGoogle Scholar
  77. 76.
    Hodsman AB, Sherrard DJ, Alfrey AC, Ott SM, Brickman AS, Miller NL, Maloney NA, Coburn JW, 1982: Bone aluminum and histomorphometric features of renal osteodystrophy. J Clin Endocrinol Metab 54: 539.PubMedCrossRefGoogle Scholar
  78. 76a.
    Charon SA, Delmas P, Malaval L, Chavassieux PM, Arlot M, Chapuy MC, Meunier P, 1986: Serum Bone Gla-protein in renal osteodistrophy: Comparison with bone histomor- phometry. J Clin Endocrinol Metab 63: 892.CrossRefGoogle Scholar
  79. 77.
    Felsenfeld A, Harrelson JM, Gutman RA, Wells S, Drezner MK, 1982: Osteomalacia after parathyroidectomy in patients with uraemia. Ann Intern Med 96: 34.PubMedGoogle Scholar
  80. 78.
    Reguera R, Serrano M, Fernandez Glez L, Gonzalez Carcedo A, Gonzalez Diaz, Gonzalez R, Noval, Cannata JB, 1986: Searching for other sources of aluminium contamination and exposure. Proc Eur Dial Nur Transplant Assoc Eur Renal Care Assoc 15: 60.Google Scholar
  81. 79.
    De Broe ME, Van de Vyver FL, Silva FJ, D’Haese P, Verbueken H, 1986: Measuring aluminium in serum and tissues: Overview and perspectives. Nefrologia 6: Suppl 1, 41.Google Scholar
  82. 80.
    Taylor A, Starkey B, Walker AW, 1986: Measurement of aluminium; quality of analytical results. In: Aluminium and other trace elements in renal disease. Ed; A Taylor, Balliere Tindal, London: pp. 260–273.Google Scholar
  83. 81.
    Guillard O, Pineau A, 1986: The measurement of aluminium by the worldwide interlabora- tory quality control aluminium study: Distribution and utilization of results. In: Aluminium and other trace elements in renal disease. Ed; A Taylor, Balliere Tindal, London: pp. 283–291.Google Scholar
  84. 82.
    Winney RJ, Cowie FC, Robson JS, 1986: Role of plasma aluminium in the detection and prevention of aluminium toxicity. Kidney Int 29 (suppl 18) S91.Google Scholar
  85. 83.
    De Broe ME, Van de Vyver FL, Bekaert AB, D’Haese P, Paulus G, Wiser WJ, Van Grieken R, De Wolf FA, Verbueken AH, 1984: Correlation of serum aluminium values with tissue aluminium concentration. In: Trace Elements in Renal Insufficiency. Eds; E Quellhorst, K Finke, C Fuchs, Karger basel. Contr Nephrol 38: 37.Google Scholar
  86. 84.
    Van de Vyver FL, De Broe ME, 1985: Aluminium in tissues. Clin Nephrol 24 (suppl 1) S37.Google Scholar
  87. 85.
    Ackrill P, Ralston A, Day P, 1986: Role of desferrioxamine in the treatment of dialysis encephalopathy. Kidney Int 29: (suppl 18) S104.Google Scholar
  88. 86.
    Ackrill P, 1986: Aluminium removal by desferrioxamine: clinical practice. In: Aluminium and other trace elements in renal disease. Ed; A Taylor, Balliere Tindall, London: pp. 193–99.Google Scholar
  89. 87.
    Milliner DS, Nebeker HG, Ott SM, Andress DL, Sherrard DJ, Alfrey AC, Slatopolsky EA, Coburn JW, 1984: Use of the deferoxamine infusion test in the diagnosis of aluminum- related osteodystrophy. Ann Intern Med 101: 775.PubMedGoogle Scholar
  90. 88.
    Berland Y, Charhon SA, Olmer M, Meunier PJ, 1985: Predictive value of desferrioxamine infusion test for bone aluminium deposits in hemodialyzed patients. Nephron 40: 433.PubMedCrossRefGoogle Scholar
  91. 89.
    Fournier A, Fahreer P, Leflon P, Moriniere P, Toulani M, Lambrey G, Demontis R, Sebert JL, Van de Vyver F, De Broe ME, 1984: The desferrioxamine test predicts bone aluminium body burden induced by Al(OH)3 in uremic patients but not mild histological osteomalacia. Proc Eur Dial Transplant Assoc 21: 371.Google Scholar
  92. 90.
    Malluche HH, Smith AJ, Abreo K, Faugere MC, 1984: The use of deferoxamine in the management of aluminum accumulation in bone in patients with renal failure. N Engl J Med 311: 140.PubMedCrossRefGoogle Scholar
  93. 91.
    Hodsman AB, Hood SA, Brown P, Cordy PE, 1985: Do serum aluminium levels reflect underlying skeletal aluminium accumulation and bone histology before and after chelation by deferrioxamine? J Lab Clin Med 106: 674.PubMedGoogle Scholar
  94. 92.
    Freundlich M, Zileruelo G, Faugere MC, Abitbol C, Strauss JM, Malluche H, 1986: Treatment of aluminium toxicity in infantile uremia with desferrioxamine. J Pediatr 109: 141.Google Scholar
  95. 93.
    Warady B, Ford D, Gaston C, Sedman A, Huffer W, Lum G, 1986: Aluminium intoxication in a child: Treatment with intraperitoneal desferrioxamine. Pediatrics 78: 651.PubMedGoogle Scholar
  96. 93a.
    Molitoris BA, Alfrey P, Miller NL, Hasbargen JA, Kaheny W, Alfrey A, Smith B, 1987: Efficacy of intramuscular and intraperitoneal deferoxamine for aluminum chelation. Kidney Int 31: 986.PubMedCrossRefGoogle Scholar
  97. 94.
    Coburn JW, Norris K, Nebeker G, 1986: Osteomalacia and bone disease arising from aluminium. Seminars Nephrol 6: 68.Google Scholar
  98. 95.
    Malluche HH, Abreo K, Faugere MC, 1984: Aluminium decreases turnover and mineralization of bone. An effect dependent on its localization in bone. Calcif Tissue 36: 494.Google Scholar
  99. 96.
    Vernejoul MC, Belenguer R, Halkidov H, Buisine A, Bielakoff J, Miravet L, 1985: Histomorphometric evidence of deleterous effect of aluminium on osteoblasts. Bone 6: 15.PubMedCrossRefGoogle Scholar
  100. 97.
    Charhon SA, Chavassieux PM, Chapuy MC, Boivin GY, Meunier PJ, 1985: Low rate of bone formation with or without histologic appearance of osteomalacia in patients with aluminum intoxication. J Lab Clin Med 106: 123.PubMedGoogle Scholar
  101. 98.
    Faugere MC, Amala IO, Ritz E, Malluche HH, 1986: Loss of bone resulting from accumulation of aluminum in bone of patients undergoing dialysis. J Lab Clin Med 107: 481.PubMedGoogle Scholar
  102. 99.
    Maloney NA, Ott SM, Alfrey AC, Miller NL, Coburn JW, Sherrard DJ, 1982: Histological quantitation of aluminum in iliac bone from patients with renal failure. J Lab clin Med 99: 206.PubMedGoogle Scholar
  103. 100.
    Ott SM, Maloney NA, Klein GL, Alfrey AC, Ament ME, Coburn JW, 1983: Aluminum is associated with low bone formation in patients receiving chronic parenteral nutrition. Ann Intern Med 98: 910.PubMedGoogle Scholar
  104. 101.
    Verbueken AH, Van de Vyver FL, Van Grieken RE, De Broe ME, 1985: Microanalysis in biology and medicine: ultrastructural localization of aluminum. Clin Nephrol 24: S58.Google Scholar
  105. 102.
    Faugere MC, Malluche HH, 1986: Stainable aluminum and not aluminum content reflects bone histology in dialyzed patients. Kidney Int 30: 717.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1990

Authors and Affiliations

  • Jorge B Cannata Andia
  • Jose B Diaz Lopez

There are no affiliations available

Personalised recommendations