Skip to main content
Log in

Die Toxizität des Aluminiums

The toxicity of aluminum

  • Übersicht
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Summary

In view of the increasing pollution of our environment and forest decline, growing interest has been focused on aluminum toxicity. Aluminum is one of the most abundant metals and commonly present in tap water, beverages, food, cosmetics, and pharmaceutical preparations. Thus everybody is exposed to aluminum to a greater or lesser extent. It is now beyond any doubt that aluminum intoxication may cause encephalopathy, fracturing vitamin D resistant osteomalacia, and microcytic anemia in patients with chronic renal insufficiency as well as in experimental animals. The risk of aluminum intoxication has also to be considered in several other groups. These include elderly individuals with physiologically impaired excretory renal function who are treated with aluminum — containing antacids, patients with chronic liver disease, infants who are fed highly aluminum-contaminated formula at a time when their excretory renal function has not jet fully developed, patients on total parenteral nutrition, and, possibly, patients with Alzheimer's disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

Al:

Aluminium

Cu:

Kupfer

Mg:

Magnesium

PTH:

Parathormon

sHPT:

sekundärer Hyperparathyreoidismus

PTX:

Parathyreoidektomie

EEG:

Elektroenzephalogramm

DOPA:

3,4-Dihydroxyphenylalanin

TPN:

Total Parenteral Nutrition

Literatur

  1. Ackrill P, Philip Day J, Ahmed R (1988) Aluminum and iron overload in chronic dialysis. Kidney int 33 (Suppl 24):163–167

    Google Scholar 

  2. Alfrey AC, Mishell MM, Burks J, Contiguglia SR, Rudolph H, Lewin E, Holmes JH (1972) Syndrome of dyspraxia and multifocal seizures associated with chronic hemodialysis. Trans Am Soc Artif Internal Organs 18:257–261

    Google Scholar 

  3. Alfrey AC, LeGendre GR, Kaehny WD (1976) The dialysis encephalopathy syndrome. Possible aluminum intoxication. New Engl J Med 294:184–188

    Google Scholar 

  4. Alfrey AC (1985) Gastrointestinal absorption of aluminum. Clin Nephrol (Suppl 1):84–87

    Google Scholar 

  5. Alfrey AC (1986) Aluminum metabolism. Kidney Int 29 (Suppl 18):8–11

    Google Scholar 

  6. Alfrey AC (1986) Dialysis encephalopathy. Kidney int (Suppl 18):53–57

    Google Scholar 

  7. Altmann P, Al-Salihi F, Butter K, Cutler P, Blair J, Leeming R, Cunningham J, Marsh F (1987) Serum aluminum levels and erythrocyte dihydropteridine reductase activity in patients on hemodialysis. New Engl J Med 317:80–84

    Google Scholar 

  8. Altmann P, Marsh F, Plowman D, Cunningham J (1988) Aluminium chelation therapy in dialysis patients: Evidence for inhibition of haemoglobin synthesis by low levels of aluminium. Lancet 2:1012–1015

    Google Scholar 

  9. Andress DL, Ott S, Maloney NA, Sherrard DJ (1985) Effect of parathyroidectomy on bone aluminum accumulation in chronic renal failure. New Engl J Med 312:468–473

    Google Scholar 

  10. Andress DL, Maloney NA, Endres DB, Sherrard DJ (1986) Aluminum associated bone disease in chronic renal failure: High prevalence in a long-term dialysis population. J Bone Min Res 1:391–398

    Google Scholar 

  11. Arieff AI, Cooper JD, Armstrong D, Lazarovitz VC (1979) Dementia, renal failure, and brain aluminum. Arch Intern Med 90:741–747

    Google Scholar 

  12. Berlyne GM, Ben-Ari J, Pest D, Weinberger J, Stein M, Gilmore GR, Levine R (1970) Hyperaluminaemia from aluminium resin in renal failure. Lancet 2:494–496

    Google Scholar 

  13. Berlyne GM (1979) Aluminum toxicity in man. Min Electrol Metab 2:71–73

    Google Scholar 

  14. Birchall JD, Chappell JS (1988) The chemistry of aluminum and silicon in relation to Alzheimer's disease. Clin Chem 34:265–267

    Google Scholar 

  15. Blumenthal NC, Posner AS (1984) In vitro model of aluminum — induced osteomalacia: Inhibition of hydroxyapatite formation and growth. Calcif Tissue Int 36:439–441

    Google Scholar 

  16. Bourdeau A, Plachot JJ, Cournot-Witmer G, Pointillart A, Sachs C, Balsan S (1987) Parathyroid response to aluminum in vitro: Ultrastructural changes and PTH release. Kidney Int 31:15–24

    Google Scholar 

  17. Bourdeau A, Plachot JJ, Cournot-Witmer G, Pointillart A, Sachs C, Balsan S (1983) In vitro effects of aluminum on parathyroid glands: Correspondence between hormonal secretion and ultrastructural aspects. Abstr VIIIth Conf on Calcium Regulating Hormones, Kobe, Japan, p 83A

  18. Brancaccio D, Bugiani O, Pacini L, Berlin A, Bisceglia J, Gallieni M, Surian M, Costantini S, Giordano R, Rizzica M (1985) Spinal fluid aluminium in haemodialysed uraemic patients. Proc Europ Dial Transpl Ass 22:354–359

    Google Scholar 

  19. Buchanan MR, Ihle BU, Dunn CM (1981) Hemodialysis related osteomalacia: A staining method to demonstrate aluminium. J Clin Pathol 34:1352

    Google Scholar 

  20. Campbell IR, Cass JS, Cholak J, Kehoe RA (1957) Aluminium in the environment of man. A review of his hygienic status. Arch Indust Hlth 15:359–448

    Google Scholar 

  21. Cann CE, Prussin SG, Gordan GS (1979) Aluminum uptake by the parathyroid glands. J Clin Endocr Metab 49:543–545

    Google Scholar 

  22. Chan Y, Alfrey AC, Posen S, Lissner D, Hills E, Dunstan C, Evans R, (1983) Effect of aluminum on normal and uremic rats: Tissue distribution, vitamin D metabolits, and quantitative bone histology. Calcif Tissue Int 35:344–351

    Google Scholar 

  23. Cournot-Witmer G, Zingraff J, Plachot JJ, Escaig F, Lefevre R, Boumati P, Bourdeau A, Garabedian M, Galle P, Bourdon R, Drüeke T, Balsan S (1981) Aluminum localization in bone from hemodialyzed patients: Relationship to matrix mineralization. Kidney Int 20:375–385

    Google Scholar 

  24. Cournot-Witmer G, Plachot JJ, Bourdeau A, Lieberherr M, Dorgetti V, Mendes V, Halpern S, Hemmerle J, Drüeke T, Balsan S (1986) Effect of aluminum on bone and cell localization. Kidney Int (Suppl 18):37–40

    Google Scholar 

  25. Crapper DR, Quittkat S, Krishnan SS, Dalton AJ, DeBoni U (1980) Intranuclear aluminum content in Alzheimer's disease, dialysis encephalopathy, and experimental aluminum encephalopathy. Acta Neuropathol (Berl) 50:19–24

    Google Scholar 

  26. De Vernejoul MC, Belenguer R, Halkidou H, Buisine A, Biclakoff J, Miravet L (1985) Histomorphometric evidence of deleterious effect of aluminum on osteoblasts. Bone 6:15–20

    Google Scholar 

  27. De Vernejoul MC, Messing B, Modrowski D, Bielakoff J, Buisine A, Miravet L (1985) Multifactorial low remodeling bone disease during cyclic total parenteral nutrition. J Clin Endocr Metab 60:109–113

    Google Scholar 

  28. Drüeke T (1985) Aluminiumintoxikation bei Dialysebehandlung. Med Klin 80:311–313

    Google Scholar 

  29. Drüeke T, Lacour B, Touam M, Jucquel J-P, Plachot JJ, Cournot-Witmer G, Galle P (1986) Effect of aluminum on hematopoiesis. Kidney Int 29 (Suppl 18):45–48

    Google Scholar 

  30. Dunea G, Mahurkar SD, Mamdani B, Smith EL (1978) Role of aluminum in dialysis dementia. Ann Intern Med 88:502–504

    Google Scholar 

  31. Edwardson JA, Candy JM (1989) Aluminium and the pathogenesis of senile plaques in Alzheimer's disease, Down's syndrome and chronic renal dialysis. Ann Med 21:95–98

    Google Scholar 

  32. Ellis HA (1983) Aluminum induced osteomalacia in patients with chronic renal failure and in animals. Nierenu Hochdruckkrankheiten 12:198–206

    Google Scholar 

  33. Flendrig JA, Kruis H, Das HA (1976) Aluminum intoxication. The cause of dialysis dementia. Proc Europ Dial Transpl Ass 13:355–363

    Google Scholar 

  34. Fournier A, Morinière P, Sebert JL, Dkhissi H, Atik A, Leflon P, Renaud H, Gueris J, Gregoire I, Idrissi A, Garabedian M (1986) Calcium carbonate, an aluminum-free agent for control of hyperphosphatemia, hypocalcemia, and hyperparathyroidism in uremia. Kidney Int 29 (Suppl 18):114–119

    Google Scholar 

  35. Freundlich M, Abitbol C, Zilleruelo G, Strauss J, Faugére M-C, Malluche HH (1985) Infant formula as a cause of aluminium toxicity in neonatal uraemia. Lancet 1:527–529

    Google Scholar 

  36. Fuchs D, Werner ER, Wachter H (1988) Aluminium und Dihydropteridin-Reduktase beim M. Alzheimer. Dtsch Med Wochenschr 113:877

    Google Scholar 

  37. Galle P, (1983) The role of lysosomes in the renal concentration of mineral elements. In: Hamburger J, Crosnier J, Grünfeld JP, Maxwell MH (eds) Advances in Nephrology. London, Year Book Med Publ Inc 12, pp 85–99

    Google Scholar 

  38. Ganrot PO (1986) Metabolism and possible health effects of aluminium. Environ Hlth Perspect 65:363–441

    Google Scholar 

  39. Godbold DL, Fritz E, Hüttermann A (1988) Aluminium toxicity and forest decline. Proc Natl Acad Sci USA 85:3888–3893

    Google Scholar 

  40. Goodman WG, Henry DA, Horst R, Hudelman RK, Alfrey AC, Coburn JW (1984) Parenteral aluminum administration in the dog. II. Induction of osteomalacia and effect on vitamin D metabolism. Kidney Int 25:370–375

    Google Scholar 

  41. Goodman WG (1984) Short-term aluminum administration in the rat: Reductions in bone formation without osteomalacia. J Lab Clin Med 103:749–757

    Google Scholar 

  42. Goodman WG (1986) Experimental aluminum induced bone disease. Studies in vivo. Kidney Int 29 (Suppl 18):32–36

    Google Scholar 

  43. Gorsky JE, Dietz AA, Spencer H, Osis D (1979) Metabolic balance of aluminum studied in six men. Clin Chem 25:1739–1743

    Google Scholar 

  44. Greger JL, Baier MJ (1983) Excretion and retention of low or moderate levels of aluminum by human subjects. Fd Chem Tox 21:473–476

    Google Scholar 

  45. Henning HV (1987) Dialysis-osteomalacia and renal osteodystrophy: Pathogenesis, diagnostic and clinical problems. In: Generalized Bone Diseases, Eds Kuhlencordt F, Dietsch P, Keck E, Kruse H-P. Springer, Berlin Heidelberg, pp 117–145

    Google Scholar 

  46. Henning HV (1988) Therapie mit Phosphatbindern bei chronischen Dialysepatienten. Dialyse J 22:10–17

    Google Scholar 

  47. Hodsman AB, Sherrard DJ, Wong EGC, Brickman AS, Lee DBN, Alfrey AC, Singer FR, Norman AW, Coburn JW (1981) Vitamin D resistant osteomalacia in hemodialysis patients lacking secondary hyperparathyroidism. Ann Intern Med 94:629–637

    Google Scholar 

  48. Hodsman AB, Sherrard DJ, Alfrey AC, Ott S, Brickman AS, Milliner NL, Maloney NA, Coburn JW (1982) Bone aluminum and histomorphometric features of renal osteodystrophy. J Clin Endocr Metab 54:539–546

    Google Scholar 

  49. Hughes JT (1989) Aluminium encephalopathy and Alzheimer's disease. Lancet 1:490–491

    Google Scholar 

  50. Ihle BU, Becker GJ, Kincaid-Smith P (1986) Clinical and biochemical features of aluminum-related bone disease. Kidney Int 29 (Suppl 18):80–86

    Google Scholar 

  51. Kaye M (1983) Bone marrow aluminum storage in renal failure. J Clin Pathol 36:1288–1291

    Google Scholar 

  52. Kirschbaum BB, Schoolwerth AC (1989) Acute aluminum toxicity associated with oral citrate and aluminum-containing antacids. Am J Med Sci 297:9–11

    Google Scholar 

  53. Klein GL, Ament ME, Bluestone R, Norman AW, Targoff CM, Sherrard DJ, Young JH, Coburn JW (1980) Bone disease associated with total parenteral nutrition. Lancet 2:1041–1044

    Google Scholar 

  54. Klein GL, Alfrey AC, Miller NL, Sherrard DJ, Hazlet TK, Ament ME, Coburn JW (1982) Aluminum loading during total parenteral nutrition. Am J Clin Nutr 35:1425–1429

    Google Scholar 

  55. Knoll O (1981) Diagnostik der progressiven Dialyseencephalopathie. In: Zumkley H, (Hrsg) Aluminium in der Nephrologie. Dustri Verlag Dr. Karl Feistle, München-Deisenhofen, p 23

    Google Scholar 

  56. Knoll O, Lahl H, Böckmann J, Hennig H, Unterhalt B (1986) Aluminum contamination of tap water and food. Trace Elements in Medicine 3:172–175

    Google Scholar 

  57. Kovalchik MT, Kaehny WD, Jackson T, Alfrey AC (1978) Aluminum kinetics during hemodialysis. J Lab Clin Med 92:712–716

    Google Scholar 

  58. Kraut JA, Shinaberger JH, Singer FR, Sherrard DJ, Saxton J, Hodsman AB, Miller JH, Kurokawa K, Coburn JW (1983) Parathyroid gland responsiveness to acute hypocalcemia in dialysis osteomalacia. Kidney Int 23:725–730

    Google Scholar 

  59. Lahl H, Böckmann J (1988) Zur Aluminiumkontamination von Kindernährmitteln. Nieren- u Hochdruckkrankheiten 17:224–228

    Google Scholar 

  60. Leeming JR, Blair JA (1979) Dementia, aluminium, and tetrahydrobiopterin metabolism. Lancet 2:556

    Google Scholar 

  61. Llach F, Felsenfeld AJ, Coleman MD, Keveny JJ jr, Pederson JA, Medlock TR (1986) The natural course of dialysis osteomalacia Kidney Int 29 (Suppl 18):74–79

    Google Scholar 

  62. Malluche HH, Faugère M-C, Smith AJ jr, Fiedler RM (1986) Aluminum intoxication of bone in renal failure — fact or fiction? Kidney Int 29 (Suppl 18):70–73

    Google Scholar 

  63. Markesbery WR, Ehmann WD, Hossain TLM, Alauddin M, Goodin DT (1981) Instrumental neutron activation analysis of brain aluminum in Alzheimer's disease and aging. Ann Neurol 10:511–516

    Google Scholar 

  64. Martin RB (1986) The chemistry of aluminum as related to biology and medicine. Clin Chem 32:1797–1806

    Google Scholar 

  65. Matzkies F, Köhler M, Webs B (1984) Wirkung vier verschiedener Antacida auf den Gastrointestinaltrakt und den Mineralhaushalt. Fortschr Med 102:661–665

    Google Scholar 

  66. McGonigle RJS, Parsons V (1985) Aluminium-induced anaemia in haemodialysis patients. Nephron 39:1–9

    Google Scholar 

  67. Mladenovic J (1988) Aluminum inhibits erythropoiesis in vitro. J Clin Invest 81:1661–1665

    Google Scholar 

  68. Morrissey J, Slatopolsky E (1986) Effect of aluminum on parathyroid hormone secretion. Kidney Int 29 (Suppl 18):41–44

    Google Scholar 

  69. Nebeker HG, Coburn JW (1986) Aluminum and renal osteodystrophy. Ann Rev Med 37:79–85

    Google Scholar 

  70. Netter P, Burnel D, Hutin MF, Kessler MF, Faure G (1981) Aluminium in joint tissues of patients taking aluminium hydroxide (Letter). Lancet 1:1056–1057

    Google Scholar 

  71. Netter P, Kessler MF, Burnel D, Hutin MF, Delons S, Benoit J, Gaucher A (1984) Aluminum in the joint tissues of chronic renal failure patients treated with regular hemodialysis and aluminum compounds. J Rheumatol 11:66–70

    Google Scholar 

  72. Netter P, Gaucher A, Delons S, Benoit J, Kessler M, Gillet P, Burnel D, Got C (1988) Aluminium and dialysis arthropathy (Letter). Lancet 1:886–887

    Google Scholar 

  73. Ott SM, Maloney NA, Klein GL, Alfrey AC, Ament ME, Coburn JW, Sherrard DJ (1983) Aluminum is associated with low bone formation in patients receiving chronic parenteral nutrition. Ann Intern Med 98:910–914

    Google Scholar 

  74. Parsons V, Davies C, Goode C, Ogg C, Siddiqui J (1971) Aluminum in bone from patients with renal failure. Brit Med J 4:273–275

    Google Scholar 

  75. Pierides AM, Edwards WG Jr, Cullum U Jr, McCall CT, Ellis HA (1980) Hemodialysis encephalopathy with osteomalacic fractures and muscle weaknes. Kidney Int 18:115–124

    Google Scholar 

  76. Plachot JJ, Cournot-Witmer G, Halpern S, Mendes V, Bourdeau A, Drüeke T, Galle P, Balsan S (1984) Bone ultrastructure and X-ray microanalysis of aluminum intoxicated hemodialyzed patients. Kidney Int 25:796–803

    Google Scholar 

  77. Platts MM, Goode GC, Hislop JS (1977) Composition of the domestic water supply and the incidence of fractures and encephalopathy in patients on home dialysis. Brit Med J 2:657–660

    Google Scholar 

  78. Phelps KR, Vigorita VJ, Bansal M, Einhorn TA (1988) Histochemical demonstration of iron but not aluminum in a case of dialysis associated osteomalacia. Am J Med 84:775–780

    Google Scholar 

  79. Pogglitsch H (1981) Therapie mit aluminiumhaltigen Substanzen in der Nephrologie. Nieren-u Hochdruckkrankheiten 10:210–216

    Google Scholar 

  80. Poitou P, Jablonka J, Cheymol G, Petiot J, Prognon P (1987) Etude de la résporption digestive de l'aluminium après administration orale de sucralfate. Acta Therap 13:201–207

    Google Scholar 

  81. Robertson J, Felsenfeld A, Haygood C, Llach F (1983) An animal model of aluminum (Al) induced osteomalacia (OM): Role of chronic renal failure (CRF) and parathyroid hormone (PTH). Kidney Int 23:327–335

    Google Scholar 

  82. Roth A, Nogues C, Galle P, Drüeke T (1984) Multiorgan aluminium deposits in a chronic haemodialysis patient. Virchows Arch (Pathol Anat) 405:131–140

    Google Scholar 

  83. Sedman AB, Klein GL, Merritt RJ, Miller NL, Weber KO, Gill WL, Anand H, Alfrey AC (1985) Evidence of aluminum loading in infants receiving intravenous therapy. New Engl J Med 312:1337–1343

    Google Scholar 

  84. Sherrard DJ (1986) Aluminum and renal osteodystrophy. Semin Nephrol (Suppl):5–11

    Google Scholar 

  85. Short AIK, Winney RJ, Robson JJ (1980) Reversible microcytic hypochromic anemia in dialysis patients due to aluminum intoxication. Proc Europ Dial Transpl Ass 17:226–233

    Google Scholar 

  86. Slanina P, Frech W, Ekstrom L, Loof L, Slorach S, Cedergren A (1986) Dietary citric acid enhances absorption of aluminum in antacids. Clin Chem 32:539–541

    Google Scholar 

  87. Slatopolsky E (1987) The interaction of parathyroid hormone and aluminum in renal osteodystrophy. Kidney Int 31:842–854

    Google Scholar 

  88. Smith AJ, Faugére M-C, Abreo K, Fanti P, Julian B, Malluche HH (1986) Aluminum-related bone disease in mild and advanced renal failure: Evidence for high prevalence and morbidity and studies on etiology and diagnosis. Am J Nephrol 6:275–283

    Google Scholar 

  89. Trapp GA (1983) Plasma aluminum is bound to transferrin. Life Sci 33:311–316

    Google Scholar 

  90. Trapp GA, Cannon JB (1981) Aluminum pots as sources of dietary aluminum (Letter). New Engl J Med 304:172

    Google Scholar 

  91. Trapp GA (1986) Interactions of aluminum with cofactors, enzymes, and other proteins. Kidney Int 29 (Suppl 18):12–16

    Google Scholar 

  92. Ulrich B (1981) Eine ökosystemare Hypothese über die Ursachen des Tannensterbens (Abies alba Mill.) Forstwiss Centralbl 100:228–236

    Google Scholar 

  93. Van de Vyver FL, Vanheule AO, Verbueken AH, D'Haese P, Visser WJ, DeBroe ME (1984) Patterns of iron storage in patients with severe renal failure. Contrib Nephrol 38:153–166

    Google Scholar 

  94. Van de Vyver FL, DeBroe ME (1985) Aluminum in tissues. Clin Nephrol 24 (Suppl 1):37–57

    Google Scholar 

  95. Vargas JH, Klein GL, Ament ME, Ott SM, Sherrard DJ, Horst RL, Berquist WE, Alfrey AC, Slatopolsky E, Coburn JW (1988) Metabolic bone disease of total parenteral nutrition: course after changing from casein to amino acids in parenteral solutions with reduced aluminum content. Am J Clin Nutr 48:1070–1078

    Google Scholar 

  96. Verbueken AH, Van de Vyver FL, Van Gieken RE (1984) Ultrastructural localization of aluminum in patients with dialysis-associated osteomalacia. Clin Chem 30:763–768

    Google Scholar 

  97. Wilhelm M (1988) Aluminium und Alzheimer Krankheit. Dtsch Med Wochenschr 113:276

    Google Scholar 

  98. Williams JW, Vera SR, Peters IG, Luther RW, Bhattachary S, Spears H, Graham H, Pitcock JA, Crawford AK (1986) Biliary excretion of aluminum in aluminum osteodystrophy with liver disease. Ann Intern Med 104:782–785

    Google Scholar 

  99. Winterberg B, Bertram HP, Remmers S, Remmers J, Zumkley H (1986) Plasma- und Gewebsaluminiumkonzentrationen bei Dialyse-Patienten unter Therapie mit verschiedenen aluminiumhaltigen Phosphatbindern. Nieren- u Hochdruckkrankheiten 15:183–186

    Google Scholar 

  100. Yokel RA, Provan SD, Meyer JJ, Campbell SR (1988) Aluminum intoxication and the victim of Alzheimer's disease: Similarities and differences. Neurotoxicol 9:429–442

    Google Scholar 

  101. Zumkley H, Knoll O, Graefe U, Bertram HP, Lison A, Zidek W (1983) Klinik der Dialysenezephalopathie. In: Schulz W (Hrsg) Spurenelemente in der Nephrologe. Dustri Verlag Dr. Karl Feistle, München-Deisenhofen, S 27

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Henning, H.V. Die Toxizität des Aluminiums. Klin Wochenschr 67, 1221–1228 (1989). https://doi.org/10.1007/BF01745293

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01745293

Key words

Navigation