Measurements of Fast Heterogeneous Kinetics by Analysing Steady-State Cycling Voltammetries

the workplace for nephrotoxicants, and elimination or control of any found. Further, it involves identification of other risk factors, not necessarily of an occupational nature, that may interact with occupational nephrotoxic factors (Porter 1989).

In the case of severe renal injury, which is usually chronic, uraemia can occur. This condition was thought to be so serious in the past that it was considered terminal. Kidney transplants and/or periodic dialysis offer some hope for rehabilitation, although not for occupations which require anything more than moderate effort.

In acute renal disease (whether of occupational or other causes), the prospects for rehabilitation depend on the extent of recovery. Resumption of normal work is more difficult for individuals who still have residual kidney damage. However, subject to continuing medical evaluation, a gradual return to work of a ‘light duties’ type may be permitted (Rom 1998). Return to any job where manual labour is required is unlikely to be permitted.

Summary

The functional integrity of the kidney is vital. The kidney plays a number of roles and has a number of functions, including maintenance of fluid volume, excretion of soluble wastes and metabolism. While the kidney has considerable functional reserve and regenerative capacities, the nature and severity of kidney damage has the potential for significant health problems.

There are a range of workplace risks that can affect kidney function. Most, but not all of these can be characterised as chemical; others, such as traumatic shock, heat stroke and crush syndrome also exist.

The action of nephrotoxic substances may be direct or indirect. In the former, a chemical interacts directly with renal cells, and has an effect on the structure or functioning of the kidney; the effect is normally dose-related. Indirect action means that the nephrotoxic effect is produced by reactive metabolites or by immune mechanisms;

these tend to be delayed in onset and less likely to be dose-related. In addition, toxicants can have a secondary effect on the kidney through effects elsewhere (for example, systemic hypertension). Underlying disease, be it renal or systemic, can also affect the manifestation of nephrotoxicity.

Mild kidney damage can be identified easily, and full rehabilitation is possible. More severe cases may be fully or partially rehabilitated. However, very severe cases where kidney failure has occurred, often means the end of employment, requiring long-term dialysis treatment and/or kidney transplantation.

As ever, the risk management approach of identifying, assessing and controlling offers the best approach for preventing occupational kidney disease. Often, identification of even mild kidney damage indicates significant, and entirely preventive, exposure to workplace risks.

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Occupational toxicology of the nervous