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Membranous Nephropathy and Formaldehyde Exposure
- Peter Breysse;
- William G. Couser;
- Charles E. Alpers;
- Karen Nelson;
- Lakshmi Gaur; and
- Richard J. Johnson
- From the University of Washington and the Puget Sound Blood Center, Seattle, Washington. Acknowledgments: The authors thank Mr. Tom Collins for initially suggesting this association and Drs. Linda Rosenstock, Jean Nokes, Ilan Zawadski, and Sandra Watkins for their assistance. Grant Support: By U.S. Public Health Service grants DK43422 and DK 02142.
Membranous nephropathy is the most common cause of idiopathic nephrotic syndrome in adults. Some cases are associated with autoimmune disorders (for example, systemic lupus erythematosus), infections (for example, hepatitis B), drugs (for example, gold or penicillamine), heavy metals (for example, mercury), organic solvents, or cancer, but most cases are idiopathic [1, 2]. We describe four patients who developed membranous nephropathy after exposure to toxic concentrations of formaldehyde commonly found in homes with certain types of insulation or cabinetry. Formaldehyde may induce membranous nephropathy in genetically susceptible persons.
Methods
Four patients with membranous nephropathy were referred to us with possible exposure to toxic concentrations of formaldehyde. Air-borne formaldehyde concentrations were measured as recommended by the National Institute of Occupational Safety and Health [3]. Standard microcytotoxicity assays were used to serologically type histocompatibility leukocyte (HLA) antigens. We identified HLA-DR β sequences from enzymatically amplified DNA by a modified reverse blot assay [4] that used sequence-specific oligonucleotide probes.
Results
All four patients presented with the nephrotic syndrome. Biopsy specimens …
