Carbon Disulfide Nephropathy - Symptoms and Treatment

Introduction

Carbon disulfide (CS2), in its pure form, is a colorless, volatile, and flammable liquid with a sweet aromatic scent. This technical product is an unpleasant-smelling yellowish liquid. Carbon disulfide is utilized in large quantities as an industrial chemical to produce carbon disulfide viscose fiber. It is very harmful in nature if inhaled and absorbed by the body. The main source of carbon disulfide in the environment is emissions from viscose factories, especially in areas with severe environmental pollution. The main cause of environmental pollution (internal and external) is carbon disulfide:

• Air- Emissions from viscose factories.

• Inhalation- Inhalation is the main route of exposure to carbon disulfide, both at work and in professional life.

• Drinking Water- Carbon disulfide can enter the water via wastewater from viscose factories. Drinking water usually does not contain carbon disulfide.

• Food- Carbon disulfide can contaminate juices and wines distilled from grapes that are harvested in vineyards treated with carbon disulfide.

• Other Routes of Exposure- Skin uptake of carbon disulfide may represent another route of entry.

What Is Carbon Disulfide-Induced Nephropathy?

Nephropathy is a decrease in kidney function. The end stage of nephropathy is known as renal failure, end-stage renal disease, or ESRD. Carbon disulfide causes extremely toxic effects on the kidney by causing inflammation of the glomerulus (functional unit of the kidney), also called glomerulonephritis. People with a long-term history of carbon disulfide exposure typically end up with end-stage renal disease or kidney failure. There is the presence of reduced urine output and increased urine protein and amino acids.

What Are the Risk Factors for Carbon Disulfide-Induced Nephropathy?

The main risk factors for exposure to carbon disulfide are:

• The primary route of exposure to this compound is the workplace. Workers in facilities using carbon disulfides during the manufacturing process have a high potential for exposure.

• Carbon disulfide emissions from industrial processes are mostly airborne. Individuals in proximity to these places can be exposed. The concentration of carbon disulfide in urban and suburban areas is about 65 parts per trillion (ppt) and about 41 ppt in rural areas, respectively.

• Carbon disulfide was detected in some drinking water samples.

• Small amounts of carbon disulfide are naturally emitted from volcanoes and wetlands.

What Are the Symptoms of Carbon Disulfide-Induced Nephropathy?

The signs and symptoms of carbon dioxide-induced nephropathy include:

• Decreased urine output.

• Fluid retention, resulting in swelling of the feet, ankles, or feet.

• Difficulty in breathing.

• Malaise.

• Confusion.

• Nausea.

• Weakness.

• Irregular heartbeat.

• Chest pain or pressure.

• Seizures or coma in severe cases.

When to Get Help for Carbon Disulfide-Induced Nephropathy?

Patients should seek immediate medical help in case any of the following signs and symptoms are elicited -

• Dizziness.

• Vomiting.

• Decreased urine output.

• Swelling in the body.

• Fever.

• Confusion.

• Breathlessness.

How Is Carbon Disulfide-Induced Nephropathy Diagnosed?

Carbon disulfide-induced nephropathy is diagnosed by doctors in the ways listed below:

• Case History- History of exposure to carbon disulfide is recorded by the doctors along with any other comorbidities noticed. All the physical symptoms are noticed and recorded by the doctors.

• Blood Tests- Blood tests may show rapidly elevated levels of urea and creatinine - the two substances used to measure kidney function.

• Imaging Tests- Imaging tests, such as ultrasound and computed tomography, help doctors assess the kidneys.

• Urine Volume Measurement- Measuring urine output over a 24-hour period can help doctors identify the cause of nephropathy.

• Urinalysis- Analysis of a urine sample (urinalysis) can reveal abnormalities that indicate nephropathy..

• Kidney Biopsy- In some circumstances, doctors may recommend a kidney biopsy to obtain a small sample of kidney tissue for laboratory tests. The sample is taken out with a biopsy needle.

What Is the Treatment of Carbon Disulfide-Induced Nephropathy?

Carbon disulfide-induced nephropathy is treated in the following ways:

• Intravenous Fluid Replacement- In case acute renal failure is caused by a lack of water in the blood, the doctor may recommend intravenous (IV) fluids. Nephropathy can also cause excess fluid retention in the body, causing swelling of the arms and legs. In such cases, doctors recommend drugs, such as diuretics (also known as water pills) to help the body eliminate excess water.

• Dialysis- Dialysis removes toxins from the blood. Temporary hemodialysis (often simply called dialysis) may be necessary if toxins build up in the blood. This is to remove toxins and excess water from the body while the kidneys heal. Dialysis also helps remove excess potassium from the body. During the process of dialysis, a machine pumps blood out of the body through an artificial kidney (dialyzer) that filters waste products. The blood is then returned to the body.

• Kidney Transplant- In severe cases and end-stage renal disease, a transplant of the kidney may be the only option to save a person’s life.

What Are the Complications of Carbon Disulfide-Induced Nephropathy?

The potential complications of acute renal failure include:

• Fluid Accumulation in the Body- Acute renal failure can give rise to fluid accumulation in the lungs, causing shortness of breath.

• Chest Pain- Inflammation of the membrane that covers the heart (pericardium) can cause chest pain.

• Weakness- Muscle weakness occurs when the body's water and electrolytes (the body's blood chemistry) are out of balance.

• Permanent Kidney Damage- In some cases, acute renal failure can lead to permanent loss of kidney function or the development of end-stage renal disease. Patients with end-stage renal disease mostly need either permanent dialysis (a mechanical filtration process used to remove toxins and waste products from the body) or a kidney transplant to survive.

• Mortality- Acute renal failure can lead to loss of kidney function and eventual death.

How to Prevent Carbon Disulfide-Induced Nephropathy?

Carbon disulfide-induced nephropathy can be prevented in the following ways:

• Avoid working in an industrial environment where exposure to carbon disulfide can be present.

• Wearing a mask outdoors to avoid inhalation of the industrial carbon disulfide.

• Wearing a physical protective kit to prevent carbon disulfide from contacting the skin.

• Washing hands and face after every possible exposure to carbon disulfide.

• Getting the drinking water checked for carbon disulfide presence and proper treatment of water before drinking.

Conclusion

Inhalation of carbon disulfide is the main mechanism of exposure to this harmful industrial chemical. Long-term exposure to it may cause increased renal symptoms along with neurological symptoms. The more a person is exposed to it, the higher the chances of permanent renal damage. With permanent renal damage and nephropathy, there is an elevated risk of death or poor quality of life. Proper measures should be taken to limit the exposure of the workers and residents of the industrial area to carbon disulfide. The waste management protocol of a factory should be followed diligently, and all workers should be given proper protective gear for their safety.