title: IgA nephropathy in a laboratory worker that progressed to end-stage renal disease: a case report.
abstract: 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.
  
  
  METHODS
  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.
authors: Program of Occupational and Environmental Medicine, Graduate School of Public Health, Seoul National University, Gwankakro 1, Gwanak-gu, Seoul 151-600 Republic of Korea.
authors: Bokki
authors: B
authors: Min
authors: Program of Occupational and Environmental Medicine, Graduate School of Public Health, Seoul National University, Gwankakro 1, Gwanak-gu, Seoul 151-600 Republic of Korea.
authors: Gyuree
authors: G
authors: Kim
authors: Department of Environmental and Safety Engineering, Ajou University, 206 Worldcup-ro, Yeongtong-Gu, Suwon, 443-749, Republic of Korea.
authors: Taesun
authors: T
authors: Kang
authors: Department of Environmental Health, Graduate School of Public Health, Seoul National University, Gwankakro 1, Gwanak-gu, Seoul 151-600 Republic of Korea.
authors: Chungsik
authors: C
authors: Yoon
authors: Program of Occupational and Environmental Medicine, Graduate School of Public Health, Seoul National University, Gwankakro 1, Gwanak-gu, Seoul 151-600 Republic of Korea.
authors: Sung-Il
authors: SI
authors: Cho
authors: Program of Occupational and Environmental Medicine, Graduate School of Public Health, Seoul National University, Gwankakro 1, Gwanak-gu, Seoul 151-600 Republic of Korea.
authors: Domyung
authors: D
authors: Paek
keywords: Dichloromethane; End-stage renal disease; IgA nephropathy; Laboratory worker; Occupational exposure; Organic solvent; Toluene