CORRELATION OF DRUG-RELATED ALUMINUM INTAKE AND DIALYSIS TREATMENT WITH DEPOSITION OF ARGYROPHILIC ALUMINUM-CONTAINING INCLUSIONS IN CNS AND IN ORGAN SYSTEMS OF PATIENTS WITH DIALYSIS-ASSOCIATED ENCEPHALOPATHY

CNS tissue and peripheral organs of 50 autopsy cases with chronic rena l failure (CRF) and dialysis treatment were evaluated for aluminum- (A l) containing argyrophilic inclusions using the Howell and Black metho d modified by Reusche. Morphological alterations were correlated with the duration of hemodialysis (HD) and to the amount of prescribed Al-c ontaining drugs for better control of hyperphosphatemia. Significant c orrelations were found between the degree of morphological alterations and Al intake up to 2,5 kg (p = 0.0003), as well as for morphology an d duration of longterm HD up to 178 months (p = 0,001). Most sensitive structure for CNS deposits were choroid epithelia, followed by glial cells and neurons. Autonomic ganglia, heart, ovary/testis, parathyroid , adrenal, and pituitary demonstrated reliably peripheral deposits. Al -containing drugs, administered preferentially during HD, explain the additional significance of Al uptake and duration of diaylsis (R-Qu. = 0.6697). The deposition of Al-containing proteinaceous inclusions is apparently irreversible. After renal transplantation, with termination of drug-related Al intake and normalized renal Al excretion, the Al-i nduced argyrophilic degradation products remained in the cellular cyto plasm in unchanged fashion up to 10 years.