Occupational Exposure
Some of the workplaces that have a higher risk of nephrotoxicity usually include hospitals, laboratories, and sanitation jobs. A few of the main nephrotoxins that these workers might be exposed to include heavy metals, solvents, chemicals, and even compounds that are found in certain medicines.(1) There is a higher risk is due to these workers being exposed to these substances more often. Workers that are employed in these workplaces can be exposed through the inhalation, dermal contact, or ingestion of these substances. For example, laboratory worker have to deal with chemicals like formaldehyde and other solvent-based chemicals, which can build up in the kidneys.(3) Healthcare workers can be exposed to some of the substances that can be found in certain medicines.(4) Sanitation workers can be exposed through the cleaning products that they work with. The longer you are exposed to these substances, the higher chance your kidney is going to be affected by the poisonous effects of the nephrotoxins. This means that the kidneys will lose their ability to filter waste, and can lead to nephrotoxicity or kidney disease.(2) [7]
Prevention and Control
Preventing nephrotoxicity in medical and hospital settings requires a multi step approach, including preventative measures and control and response to people that have been exposed. This begins with integrating in substitutions for harmful nephrotoxic chemicals, creating exposure controls, proper administrative policies, and appropriate Personal Protective Equipment (PPE). [8] [9] [10] [11] [12] [13] Another important step is control and response, early detection of symptoms, and symptom monitoring for workers and patients that may have higher exposure levels to chemicals that cause nephrotoxicity. [10]
Medical settings have several different ways of preventing and minimizing the risk of nephrotoxicity. Substitutions to nephrotoxic chemicals commonly used in the medical setting should include replacing disinfectants, solvents, antibiotics, chemotherapy drugs, and Non-steroidal Anti-Inflammatory Drugs (NSAIDS) with safer chemicals for healthcare workers and patients to use. [8] Hospital settings should also provide exposure controls like closed system drug transfer devices, maintaining good ventilation in rooms where drugs are being used, and biological safety cabinets. [10] Solid administrative controls like proper labelling, hazard communication, training programs for employees, and using Safety Data Sheets (SDS) can minimize the risk of exposure further. [9] Employees should be required to wear proper PPE when handling nephrotoxic substances: including gloves, full coverage safety gowns, and respiratory protection over their mouth and nose. [8]
Control and response is also important, and can include baseline and periodic kidney function testing among exposed workers and patients, [11] and having protocols for hazardous waste disposal/management and contamination cleanup. [9] If there is a chemical spill or direct exposure, there should be spill kits, emergency eyewash stations, and immediate medical attention and evaluations offered. [9] Using good waste disposal protocols can also help prevent contamination and cross-contamination of healthcare workers and patients. [12] Patients that must be given nephrotoxic substances should have kidney testing and monitoring evaluations done before and after the drugs are administered to ensure that they receive medical treatment as needed for any resulting nephrotoxicity symptoms. [13]
