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Organ distribution of endogenous p-cresol in hemodialysis patients

Natsuki Ikematsu1, Masayuki Kashiwagi1, Kenji Hara1

  • 1Department of Forensic Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.

The Journal of Medical Investigation : JMI
|May 9, 2019
PubMed

Insights

p-Cresol accumulates in hemodialysis (HD) patients, showing significantly higher concentrations in blood, urine, and organs compared to non-HD individuals. This study details p-cresol

Area of Science:

  • Toxicology
  • Nephrology
  • Forensic Science

Background:

  • Elevated p-cresol levels are observed in the blood of hemodialysis (HD) patients.
  • The organ distribution of p-cresol in HD patients has not been extensively studied.
  • Forensic autopsy cases provide a unique opportunity to investigate p-cresol distribution.

Purpose of the Study:

  • To investigate the organ distribution of p-cresol in hemodialysis patients.
  • To compare p-cresol concentrations in blood, urine, and various organs between HD and non-HD individuals.
  • To analyze the forms of p-cresol (conjugated and protein-bound) in urine and organs.

Main Methods:

  • Measurement of p-cresol in blood, urine, lungs, liver, and kidneys from HD and non-HD cases.
  • Sample preparation involving p-cresol-d8 internal standard, derivatization, and gas chromatography-mass spectrometry (GC-MS) analysis.
  • Quantification of total p-cresol and its conjugated forms.

Main Results:

  • Urinary p-cresol/Creatinine was 16-fold higher in HD cases (79.73 ng/ml) compared to non-HD cases.
  • Blood and kidney p-cresol concentrations were over 30-fold higher in HD patients (11.92 µg/mL and 13.08 µg/g, respectively).
  • Liver and lung p-cresol levels were approximately 20-fold higher in HD patients (4.82 µg/g and 9.99 µg/g, respectively).

Conclusions:

  • p-Cresol is markedly increased in the blood, urine, and organs of hemodialysis patients.
  • Significant differences in p-cresol distribution exist between HD and non-HD individuals.
  • Conjugated and protein-bound conjugated forms constitute a major fraction of urinary and organ-bound p-cresol in HD patients.
Abstract

Keywords:
chromic kidney diseaseforensic autopsy casehemodialysis patientsorgan distributionp-cresol

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