Sulfur Mustard-induced Changes in Blood Urea Nitrogen, Uric Acid and Creatinine Levels of Civilian Victims, and Their Correlation with Spirometric Values
-
Ensieh Sadat MIRSHARIF
,
Fatemeh HEIDARY
,
Mohammad Reza VAEZ MAHDAVI
,
Reza GHAREBAGHI
,
Shahriar POURFARZAM
,
Tooba GHAZANFARI
Abstract
Background: The aim of this study was assessment of the chronic effects of sulfur mustard (SM) among victims.
Methods: In this cohort study, 355 SM-exposed subjects from Sardasht, and 123 controls from Rabat, both from West Azerbaijan Province, Iran were included. The spirometric evaluation and the global initiative for chronic obstructive lung disease (GOLD) classification were applied for all. Serum levels of urea, creatinine (Cr), and uric acid (UA) and glomerular filtration rate (GFR) were assessed. Data analysis was conducted using IBM SPSS.
Results: All were male, with a mean age of 43.7±10.7 and 41.6±9.9 years in case and control groups, respectively. The case group had significantly higher values of Cr (P<0.001) and UA (P=0.018) than the control group. This was also the case in the Cr level (P<0.001) in subjects without pulmonary dysfunction, between both groups. There was significant difference in the GFR (P=0.047) between both groups and between sub-groups with pulmonary dysfunction in the case and control groups (P=0.045), as well as between SM-exposed subjects with and without pulmonary dysfunction (P=0.009). Serum Cr, UA, sUA/Cr ratio, and BUN as well as the GFR did not have any significant correlation with forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio.
Conclusion: Despite significantly high levels of Cr and UA in the case group, no significant correlation was found between serum Cr, UA, sUA/Cr ratio, BUN, and GFR with spirometric values. Further studies are required to reveal the underlying molecular and clinical significance of these findings.
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2. Nadoushan MRJ, Ghazanfari T, Yaraee R et al (2009). Total serum bilirubinemia and intensity of sulfur mustard exposure in Iranian chemical victims 20 years after exposure. Toxin Reviews, 28)1): 44-47.
3. Liu F, Jiang N, Xiao ZY et al (2016). Effects of poly (ADP-ribose) polymerase-1 (PARP-1) inhibition on sulfur mustard-induced cutaneous injuries in vitro and in vivo. PeerJ, 4:e1890.
4. Fan LJ, Bernstein IA (1991). Effect of bis(beta-chloroethyl)sulfide (BCES) on base mismatch repair of DNA in mon-key kidney cells. Toxicol Appl Pharmacol, 111(2):233-41.
5. Clemedson CJ, Kristoffersson H, Soerbo B, Ullberg S (1963). Whole body autoradio-graphic studies of the distribution of sul-phur 35-labelled mustard gas in mice. Ac-ta Radiol Ther Phys Biol, 1:314-20.
6. Ozbek E (2012). Induction of oxidative stress in kidney. Int J Nephrol, 2012:465897.
7. Jayasundera S, Macnab R (2012). Laboratory tests of renal function. Anaesthesia & Inten-sive Care Medicine, 13(7):328-331.
8. Kadowaki T, Hamada H, Yokoyama A et al (2007). Significance of serum uric acid in patients with chronic respiratory failure treated with non-invasive positive pres-sure ventilation. Intern Med, 46(11):691-7.
9. Garcia-Pachon E, Padilla-Navas I, Shum C (2007). Serum uric acid to creatinine ratio in patients with chronic obstructive pul-monary disease. Lung, 185(1):21-4.
10. Kocak ND, Sasak G, Akturk UA et al (2016). Serum Uric Acid Levels and Uric Acid/Creatinine Ratios in Stable Chronic Obstructive Pulmonary Disease (COPD) Patients: Are These Parameters Efficient Predictors of Patients at Risk for Exacer-bation and/or Severity of Disease? Med Sci Monit, 22:4169-4176.
11. Ghazanfari T, Faghihzadeh S, Aragizadeh H et al (2009). Sardasht-Iran cohort study of chemical warfare victims: design and methods. Arch Iran Med, 12(1):5-14.
12. No authors listed (1995). Standardization of Spirometry, 1994 Update. American Tho-racic Society. Am J Respir Crit Care Med, 152(3):1107-36.
13. Pauwels RA, Buist AS, Calverley PM et al (2001). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med, 163(5):1256-76.
14. Pourfarzam S, Ghazanfari T, Merasizadeh J et al (2009). Long-term pulmonary com-plications in sulfur mustard victims of Sardasht, Iran. Toxin Rev, 28(1):8-13.
15. Cockcroft DW, Gault MH (1976). Prediction of creatinine clearance from serum creati-nine. Nephron, 16(1):31-41.
16. Keramati MR, Balali-Mood M, Mousavi SR et al (2013). Biochemical and hematologi-cal findings of Khorasan veterans 23 years after sulfur mustard exposure. J Res Med Sci, 18(10):855-9.
17. Sah OSP, Qing YX (2015). Associations Be-tween Hyperuricemia and Chronic Kid-ney Disease: A Review. Nephrourol Mon, 7(3):e27233.
18. Pant SC, Vijayaraghavan R (1999). Histo-morphological and histochemical altera-tions following short-term inhalation ex-posure to sulfur mustard on visceral or-gans of mice. Biomed Environ Sci, 12(3):201-13.
19. Hassan ZM, Ebtekar M, Ghanei M, Taghi-khani M et al (2006). Immunobiological consequences of sulfur mustard contam-ination. Iran J Allergy Asthma Immunol, 5(3):101-8.
20. Azizi F, Amini M, Arbab P (1993). Time course of changes in free thyroid indices, rT3, TSH, cortisol and ACTH following exposure to sulfur mustard. Exp Clin En-docrinol, 101(5):303-6.
21. Joseph LB, Composto GM, Heck DE (2016). Tissue injury and repair following cutaneous exposure of mice to sulfur mustard. Ann N Y Acad Sci, 1378(1):118-123.
22. Sauvaigo S, Sarrazy F, Batal M et al (2016). Impact of topical application of sulfur mustard on mice skin and distant organs DNA repair enzyme signature. Toxicol Lett, 241:71-81.
23. Mei YZ, Zhang XR, Jiang N et al (2014). The injury progression of T lymphocytes in a mouse model with subcutaneous in-jection of a high dose of sulfur mustard. Mil Med Res, 1:28.
24. Visconti L, Santoro D, Cernaro V et al (2016). Kidney-lung connections in acute and chronic diseases: current perspec-tives. J Nephrol, 29(3):341-348.
25. Goswami DG, Kumar D, Tewari-Singh N et al (2015). Topical nitrogen mustard ex-posure causes systemic toxic effects in mice. Exp Toxicol Pathol, 67(2):161-170.
26. Anand T, Vijayaraghavan R, Bansal I, Bhattacharya BK (2009). Role of inflam-matory cytokines and DNA damage re-pair proteins in sulfur mustard exposed mice liver. Toxicol Mech Methods, 19(5):356-62.
27. Wormser U, Brodsky B, Proscura E, Foley JF, Jones T, Nyska A (2005). Involve-ment of tumor necrosis factor-alpha in sulfur mustard-induced skin lesion; effect of topical iodine. Arch Toxicol, 79(11):660-70.
28. Ghassemi-Broumand M, Aslani J, Emadi SN (2008). Delayed ocular, pulmonary, and cutaneous complications of mustards in patients in the city of Sardasht, Iran. Cutan Ocul Toxicol, 27(4):295-305.
29. Ghasemi H, Ghazanfari T, Yaraee R et al (2009). Evaluation of relationship be-tween the serum levels of inflammatory mediators and ocular injuries induced by sulfur mustard: Sardasht-Iran Cohort Study. Int Immunopharmacol, 9(13-14):1494-8.
30. Yaraee R, Ghazanfari T, Ebtekar M et al (2009). Alterations in serum levels of in-flammatory cytokines (TNF, IL-1alpha, IL-1beta and IL-1Ra) 20 years after sulfur mustard exposure: Sardasht-Iran cohort study. Int Immunopharmacol, 9(13-14):1466-70.
31. Yoshizawa T, Okada K, Furuichi S et al (2015). Prevalence of chronic kidney dis-eases in patients with chronic obstructive pulmonary disease: assessment based on glomerular filtration rate estimated from creatinine and cystatin C levels. Int J Chron Obstruct Pulmon Dis, 10:1283-9.
32. Hopkins D, Daniels T, Marinio L, Parsons E (2015). The association between nutri-tional status, serum creatinine and lung function in adults with cystic fibrosis. J Cyst Fibros, 14(Suppl 1):S117.
33. Incalzi RA, Corsonello A, Pedone C et al (2010). Chronic renal failure: a neglected comorbidity of COPD. Chest, 137(4):831-7.
34. Chen CY, Liao KM (2016). Chronic Ob-structive Pulmonary Disease is associated with risk of Chronic Kidney Disease: A Nationwide Case-Cohort Study. Sci Rep, 6:25855.
35. Wehbe E, Brock R, Budev M et al (2012). Short-term and long-term outcomes of acute kidney injury after lung transplanta-tion. J Heart Lung Transplant. 31(3):244-51.
36. Kim YS, Kim HY, Ahn HS et al (2016). Glomerular filtration rate affects interpre-tation of pulmonary function test in a Korean general population: results from the Korea National Health and Nutrition Examination Survey 2010 to 2012. Korean J Intern Med, 31(6):1101-1109.
37. Kumar O, Vijayaraghavan R (1998). Effect of sulphur mustard inhalation exposure on some urinary variables in mice. J Appl Toxicol, 18(4):257-9.
2. Nadoushan MRJ, Ghazanfari T, Yaraee R et al (2009). Total serum bilirubinemia and intensity of sulfur mustard exposure in Iranian chemical victims 20 years after exposure. Toxin Reviews, 28)1): 44-47.
3. Liu F, Jiang N, Xiao ZY et al (2016). Effects of poly (ADP-ribose) polymerase-1 (PARP-1) inhibition on sulfur mustard-induced cutaneous injuries in vitro and in vivo. PeerJ, 4:e1890.
4. Fan LJ, Bernstein IA (1991). Effect of bis(beta-chloroethyl)sulfide (BCES) on base mismatch repair of DNA in mon-key kidney cells. Toxicol Appl Pharmacol, 111(2):233-41.
5. Clemedson CJ, Kristoffersson H, Soerbo B, Ullberg S (1963). Whole body autoradio-graphic studies of the distribution of sul-phur 35-labelled mustard gas in mice. Ac-ta Radiol Ther Phys Biol, 1:314-20.
6. Ozbek E (2012). Induction of oxidative stress in kidney. Int J Nephrol, 2012:465897.
7. Jayasundera S, Macnab R (2012). Laboratory tests of renal function. Anaesthesia & Inten-sive Care Medicine, 13(7):328-331.
8. Kadowaki T, Hamada H, Yokoyama A et al (2007). Significance of serum uric acid in patients with chronic respiratory failure treated with non-invasive positive pres-sure ventilation. Intern Med, 46(11):691-7.
9. Garcia-Pachon E, Padilla-Navas I, Shum C (2007). Serum uric acid to creatinine ratio in patients with chronic obstructive pul-monary disease. Lung, 185(1):21-4.
10. Kocak ND, Sasak G, Akturk UA et al (2016). Serum Uric Acid Levels and Uric Acid/Creatinine Ratios in Stable Chronic Obstructive Pulmonary Disease (COPD) Patients: Are These Parameters Efficient Predictors of Patients at Risk for Exacer-bation and/or Severity of Disease? Med Sci Monit, 22:4169-4176.
11. Ghazanfari T, Faghihzadeh S, Aragizadeh H et al (2009). Sardasht-Iran cohort study of chemical warfare victims: design and methods. Arch Iran Med, 12(1):5-14.
12. No authors listed (1995). Standardization of Spirometry, 1994 Update. American Tho-racic Society. Am J Respir Crit Care Med, 152(3):1107-36.
13. Pauwels RA, Buist AS, Calverley PM et al (2001). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med, 163(5):1256-76.
14. Pourfarzam S, Ghazanfari T, Merasizadeh J et al (2009). Long-term pulmonary com-plications in sulfur mustard victims of Sardasht, Iran. Toxin Rev, 28(1):8-13.
15. Cockcroft DW, Gault MH (1976). Prediction of creatinine clearance from serum creati-nine. Nephron, 16(1):31-41.
16. Keramati MR, Balali-Mood M, Mousavi SR et al (2013). Biochemical and hematologi-cal findings of Khorasan veterans 23 years after sulfur mustard exposure. J Res Med Sci, 18(10):855-9.
17. Sah OSP, Qing YX (2015). Associations Be-tween Hyperuricemia and Chronic Kid-ney Disease: A Review. Nephrourol Mon, 7(3):e27233.
18. Pant SC, Vijayaraghavan R (1999). Histo-morphological and histochemical altera-tions following short-term inhalation ex-posure to sulfur mustard on visceral or-gans of mice. Biomed Environ Sci, 12(3):201-13.
19. Hassan ZM, Ebtekar M, Ghanei M, Taghi-khani M et al (2006). Immunobiological consequences of sulfur mustard contam-ination. Iran J Allergy Asthma Immunol, 5(3):101-8.
20. Azizi F, Amini M, Arbab P (1993). Time course of changes in free thyroid indices, rT3, TSH, cortisol and ACTH following exposure to sulfur mustard. Exp Clin En-docrinol, 101(5):303-6.
21. Joseph LB, Composto GM, Heck DE (2016). Tissue injury and repair following cutaneous exposure of mice to sulfur mustard. Ann N Y Acad Sci, 1378(1):118-123.
22. Sauvaigo S, Sarrazy F, Batal M et al (2016). Impact of topical application of sulfur mustard on mice skin and distant organs DNA repair enzyme signature. Toxicol Lett, 241:71-81.
23. Mei YZ, Zhang XR, Jiang N et al (2014). The injury progression of T lymphocytes in a mouse model with subcutaneous in-jection of a high dose of sulfur mustard. Mil Med Res, 1:28.
24. Visconti L, Santoro D, Cernaro V et al (2016). Kidney-lung connections in acute and chronic diseases: current perspec-tives. J Nephrol, 29(3):341-348.
25. Goswami DG, Kumar D, Tewari-Singh N et al (2015). Topical nitrogen mustard ex-posure causes systemic toxic effects in mice. Exp Toxicol Pathol, 67(2):161-170.
26. Anand T, Vijayaraghavan R, Bansal I, Bhattacharya BK (2009). Role of inflam-matory cytokines and DNA damage re-pair proteins in sulfur mustard exposed mice liver. Toxicol Mech Methods, 19(5):356-62.
27. Wormser U, Brodsky B, Proscura E, Foley JF, Jones T, Nyska A (2005). Involve-ment of tumor necrosis factor-alpha in sulfur mustard-induced skin lesion; effect of topical iodine. Arch Toxicol, 79(11):660-70.
28. Ghassemi-Broumand M, Aslani J, Emadi SN (2008). Delayed ocular, pulmonary, and cutaneous complications of mustards in patients in the city of Sardasht, Iran. Cutan Ocul Toxicol, 27(4):295-305.
29. Ghasemi H, Ghazanfari T, Yaraee R et al (2009). Evaluation of relationship be-tween the serum levels of inflammatory mediators and ocular injuries induced by sulfur mustard: Sardasht-Iran Cohort Study. Int Immunopharmacol, 9(13-14):1494-8.
30. Yaraee R, Ghazanfari T, Ebtekar M et al (2009). Alterations in serum levels of in-flammatory cytokines (TNF, IL-1alpha, IL-1beta and IL-1Ra) 20 years after sulfur mustard exposure: Sardasht-Iran cohort study. Int Immunopharmacol, 9(13-14):1466-70.
31. Yoshizawa T, Okada K, Furuichi S et al (2015). Prevalence of chronic kidney dis-eases in patients with chronic obstructive pulmonary disease: assessment based on glomerular filtration rate estimated from creatinine and cystatin C levels. Int J Chron Obstruct Pulmon Dis, 10:1283-9.
32. Hopkins D, Daniels T, Marinio L, Parsons E (2015). The association between nutri-tional status, serum creatinine and lung function in adults with cystic fibrosis. J Cyst Fibros, 14(Suppl 1):S117.
33. Incalzi RA, Corsonello A, Pedone C et al (2010). Chronic renal failure: a neglected comorbidity of COPD. Chest, 137(4):831-7.
34. Chen CY, Liao KM (2016). Chronic Ob-structive Pulmonary Disease is associated with risk of Chronic Kidney Disease: A Nationwide Case-Cohort Study. Sci Rep, 6:25855.
35. Wehbe E, Brock R, Budev M et al (2012). Short-term and long-term outcomes of acute kidney injury after lung transplanta-tion. J Heart Lung Transplant. 31(3):244-51.
36. Kim YS, Kim HY, Ahn HS et al (2016). Glomerular filtration rate affects interpre-tation of pulmonary function test in a Korean general population: results from the Korea National Health and Nutrition Examination Survey 2010 to 2012. Korean J Intern Med, 31(6):1101-1109.
37. Kumar O, Vijayaraghavan R (1998). Effect of sulphur mustard inhalation exposure on some urinary variables in mice. J Appl Toxicol, 18(4):257-9.
| Files | ||
| Issue | Vol 47 No 11 (2018) | |
| Section | Original Article(s) | |
| Keywords | ||
| SM-exposed Urea Creatinine Uric acid Glomerular filtration rate | ||
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How to Cite
1.
MIRSHARIF ES, HEIDARY F, VAEZ MAHDAVI MR, GHAREBAGHI R, POURFARZAM S, GHAZANFARI T. Sulfur Mustard-induced Changes in Blood Urea Nitrogen, Uric Acid and Creatinine Levels of Civilian Victims, and Their Correlation with Spirometric Values. Iran J Public Health. 2018;47(11):1725-1733.
