Impact of environmental

factors to excretion and

homeostasis

Prof. Rūta Ustinavičienė

Department of environmental and
occupational medicine
Environmental factors(1)

 Physical (temperature, nonionizing

radiation, climate factors and other)
 Chemical (carcinogenic substances,
chemical substances in work
environment, food products)
Environmental factors(2)

 Natural environment (pvz. solar

radiation, climatic factors);
 Home environment (pvz. Quality of
drinking water, food products,
bathhouse);
 Occupational environment (pvz.
Carcinogenic substances, toxic
chemicals)
The term “carcinogen”

 refers to any substance, physical

factor, occupation or biological factor
that is an agent directly involved in the
promotion of cancer or in the
facilitation of its propagation.
Coordination of cancer
research
 International Agency for Research on
Cancer (IARC) is an intergovernmental
agency forming part of the World Health
Organisation of the United Nations.
 Its main offices are in Lyon, France. Its role
is to conduct and coordinate research into
the causes of cancer. It also conducts
epidemiological studies into the occurrence
of cancer worldwide.
 http://www.iarc.fr/
Evidence of cancerogenity

 Long term clinical research;

 Wide epidemiological investigation;

 Experimental research with animals;

 Short term mutagenesis research with

cells and bacteria;
 IARC classification of
carcinogens (1)
 Group 1: the agent (mixture) is definitely
carcinogenic to humans. The exposure
circumstance entails exposures that are
carcinogenic to humans
 4-Aminobiphenyl , benzidine , cyclophosphamide,
rubber industry , coke (fuel) production , tobacco
smoke, 2-Naphthylamine , Schistosoma
haematobium (infection with), cadmium and
cadmium compounds.
 IARC classification of
carcinogens (2)
 Group 2: the agent (mixture) is probably or possibly
carcinogenic to humans. The exposure circumstance
entails exposures that are probably carcinogenic to
humans.
 This category is used when there is limited evidence of
carcinogenicity in humans and sufficient evidence of
carcinogenicity in experimental animals. In some cases,
an agent (mixture) may be classified in this category
when there is inadequate evidence of carcinogenicity in
humans and sufficient evidence of carcinogenicity in
experimental animals and strong evidence that the
carcinogenesis is mediated by a mechanism that also
operates in humans.
IARC classification of
carcinogens (3)
 Group 3: The agent (mixture or exposure
circumstance) is not classifiable as to its
carcinogenicity to humans.
 This category is used most commonly for
agents, mixtures and exposure circumstances for
which the evidence of carcinogenicity is
inadequate in humans and inadequate or limited
in experimental animals.
IARC classification of
carcinogens (4)
 Group 4: The agent (mixture) is
probably not carcinogenic to humans.
 This category is used for agents or
mixtures for which there is evidence
suggesting lack of carcinogenicity in
humans and in experimental animals. .
 Schistosoma haematobium
 Schistosoma haematobium is parasite. It is a
major agent of schistosomiasis. More specifically, it
is associated with urinary schistosomiasis.
 It can break the wall of the urinary bladder causing
haematuria and cancer.
 The adult worm lives in the blood vessels of the
bladder. Since there are separate males and
females, a single worm can not produce eggs. A
female worm produces roughly 30 eggs per day. It
is these eggs that cause the pathogenicity in an
infected individual. Dark urine is a significant clinical
sign of urinary schistosomiasis.
Schistosoma haematobium - distribution

Šaltinis: University of Cambridge, Dept. of Pathology, 2009

Schistosoma haematobium
– host
Schistosoma haematobium
Life cycle of schistosoma
heamatobium
Dermatitis - schistosomiasis
 Key facts - 1

 Schistosomiasis is an acute and chronic

disease caused by parasitic worms.
 People are infected during routine agricultural,
domestic, occupational, and recreational
activities, which expose them to infested water.
 Lack of hygiene and certain play habits of
school-aged children such as swimming or
fishing in infested water make them especially
vulnerable to infection.
 Key facts - 2
 Schistosomiasis control focuses on reducing
disease through periodic, large-scale
population treatment with praziquantel; a more
comprehensive approach including potable
water, adequate sanitation, and snail control
would also reduce transmission.
 Estimates show that at least 206.5 million
people required preventive treatment for
schistosomiasis in 2016, out of which more
than 88 million people were reported to have
been treated.
Benzidine

 Carcinogenic aromatic amine;

 Has been used in the synthesis of dyes;
 In common with benzidine some other
aromatic amines such as 2-
aminonaphthalene have been withdrawn
from use in almost all industries because
they are so carcinogenic;
 It has been linked to bladder cancer and
pancreatic cancer.
 Cyklophoshamide

 Imunosupresive, chemiotherapy drug;

 Increasing risk of kidney cancer;

 It can break the wall of the urinary

bladder causing haematuria.
Haematuria is more common using
“per os” drugs, in comparison with
. injections.
Cadmium
Cadmium and cadmium
compounds in the environment
 About three-quarters of cadmium is used in
batteries (especially Ni-Cd batteries) and
most of the remaining quarter is used
mainly for pigments, coatings and plating,
and as stabilizers for plastics;
 Cd sulfide is used as a yellow pigment;
 Used in some semiconductors such as
cadmium sulfide, cadmium selenide, and
cadmium telluride, which can be used for
light detection or solar cells.
Cadmium in the environment

Environment is polluted:
 During incineration of plastics;

 Melting scrap-metals;

 Tobacco smoke (tobacco plant

contains Cd) – concentration of
cadmium in the smokers organism is
higher;
Cadmium - food (1)

 See food and variety meat contains

more Cd – till 100 μg/kg product, in
comparison with meat products;
 The main source of Cd in the food is
from potato, rice, wheat, vegetables.
Plant origin food products absorb Cd
from water.
Cadmium – food (2)

Cd goes to soil from:

1. Sludge disposal;

2. Using fosphate fertilizers (Cd salts

are in this fertilizers as additives);
3. Atmospheric pollution (acid rain
increase conversion of Cd to food).
Toxicity

 Cadmium is also a potential environmental

hazard. Human exposures to environmental
cadmium are primarily the result of the
burning of fossil fuels and municipal wastes.
 However, there have been notable
instances of toxicity as the result of long-
term exposure to cadmium in contaminated
food and water.
 The biggest risk regions – Japan and
Central Europe;
Toxicity
 In the decades following World War II, Japanese
mining operations contaminated the Jinzu River with
cadmium and traces of other toxic metals.
 Consequently, cadmium accumulated in the rice crops
growing along the riverbanks downstream of the
mines. The local agricultural communities consuming
the contaminated rice developed Itai-itai disease and
renal abnormalities, including proteinuria and
glucosuria.
 Cadmium is one of six substances banned by the
European Union's Restriction on Hazardous
Substances (RoHS) directive.
Cadmium - physiology

1. Enter organism with food and water;

2. Is accumulated in kidneys and liver;
3. Calcium in bone is replaced by Cd –
bones became porcelaine;
4. Excretion is via kidney, very slow;
5. Removed from organism in 20 years;
EUROPEAN COMMISSION
RECOMMENDATION
2014 Reduction of cadmium levels in food

(2014/193/ES)
 Cd week dose
 On average, the European population
receives about 2.3 μg Cd / kg body weight
per week.
 In the case of foods containing higher
cadmium content, about 3 μg Cd / kg can be
obtained per week.
 Vegetarians receiving about 5.4 μg Cd / kg
with food.
 Safe dose– 2,5 µg Cd/kg.
Sources of Cd in food of
Europeans
Cd levels in food reduction
methods
 Create a guidelines for farmers;
 Reducing impact of the anthropogenic
factors, such as sewage sludge,
manure use in agriculture;
 The recommendations for phosphate
fertilizers use.
Agriculture - management
Arsenic - cancerogen

 Main source – drinking water

Arsenic effects on human
body
Natural and man-made
sources
Arsenic effects on human
body
Arsenic – health risks
 Arsenic carcinogenity

 The carcinogenic potential of arsenic was

recognized over 110 years ago;
 IARC has classified arsenic as known
human carcinogen associated with tumours
of the skin, lung, urinary bladder, kidney,
liver and prostate.
Easy detectable signs of
Arsenic poisoning – skin
hyperkeratosis
Drinking water quality, drinks

 If arterial blood pressure is normal

and there is no tumefaction/ it is
recommended to use more than 2
litres per day water or other drinks,
better without soda.
 Soda water is irritating kidney;
 There isn’t proved that minerals in the
drinking water can influence
nephrolithiasis.
Water hardness types
Water hardness

 Hard water with high mineral content

isn’t related with nephrolithiasis;
 The impact of water hardness on
urinary stone formation remains
unclear. There is both negative and
positive correlation.
Relation of magnesium in drinking
water and nephrolithiasis incidence

Drinking water composition and incidence of urinary calculus: introducing a new index.
Basiri A, Shakhssalim N, Khoshdel AR, Pakmanesh H, Radfar MH.
Iran J Kidney Dis. 2011 Jan;5(1):15-20.
 Nephrolihiasis – food (1)
 High Ca concentration in urine (related with hereditary
reasons) can be regulated by diet with low concentration of
calcium
 Uric acid or urates are formed in acid conditions of urine. In
humans uric acid is the final oxidation product of purine
catabolism.
 In many instances, people have elevated uric acid levels for
hereditary reasons. Diet may also be a factor. Purines are
found in high amounts in animal food products, especially
internal organs. Examples of high purine sources include:
sweetbreads, anchovies, sardines, liver, beef kidneys, brains,
herring, mackerel, scallops, game meats, and gravy.
Nephrolihiasis – food (2)

 Phosphate stones can be formed due

to alkaline reaction of urine (
vegetarian nutrition stipulate alkaline
reaction of urine)
 The most common type of kidney
stone is composed of calcium oxalate.
 Oxalic acid is found in spinach, sorrel,
rhubarb, nuts, chocolate.
Nephrolihiasis – drugs

 Sulfanilamides;
 High doses of vitamine C;

 Drugs with steroids;

 Oral contraceptive pills;

 Drugs increasing potency;

Complex evaluation of chronic
kidney disease development

Sunil J. Wimalawansa Effect of Water Hardness on Non-Communicable Diseases , Including

Chronic Kidney Disease of Multifactorial Origin ( CKDmfo / CKDuo ) Journal of Environment and
Health Science, 2016.
Nephrolithiasis: water or food
Food additives

 Food coloring
 Preservatives ;

 Antioxidants

 Thickeners;

 Sweeteners;
Sweetener – saccharin E 954
 Saccharin is the oldest artificial sweetener. The basic
substance, benzoic sulfinide, was produced in 1878.
 Saccharin is about 300 times as sweet as sucrose,
but has an unpleasant bitter or metallic aftertaste,
especially at high concentrations.
 Saccharin is excreted with urine;
 Many studies with rats have since been performed on
saccharin, some showing a correlation between
saccharin consumption and increased frequency of
cancer (especially bladder cancer);
 PSO recomendation – dose / day 2,5mg/kg body
weight;
Sweetener – saccharin E 954

 Many studies with rats have since

been performed on saccharin, some
showing a correlation between
saccharin consumption and increased
frequency of cancer (especially
bladder cancer);
 PSO recomendation – dose / day
2,5mg/kg body weight;
 According to tradegroup operated
saccharin.org, "Concerns over saccharin's
safety were first raised twenty years ago
after a flawed study that administered huge
quantities of the sweetener to laboratory
rats produced bladder tumors in rats. New
and better scientific research has decisively
shown that the earlier rat studies are not at
all applicable to humans."
 In 1991, after fourteen years, the FDA
formally withdrew its 1977 proposal to ban
the use of saccharin, and in 2000, the U.S.
Congress repealed the law requiring
saccharin products to carry health warning
labels.
Sweetener –cyclamate E 952
 Cyclamate is an artificial sweetener that was
discovered in 1937 at the University of Illinois.
 Cyclamate is 30–50 times sweeter than sugar
 A study reported that some intestinal bacteria
could desulfonate cyclamate to produce
cyclohexylamine, a compound suspected to
have some chronic toxicity in animals. Further
research found the common 10:1 cyclamate:
saccharin mixture to increase the incidence of
bladder cancer in rats.
 It is less expensive than most sweeteners,
including sucralose, and is stable under
heating.
Sweetener –cyclamate E 952
 It is less expensive than most sweeteners,
including sucralose, and is stable under
heating.
 Other studies implicated cyclohexylamine in
testicular atrophy in mice.
 Since cyclamates appear to affect cells involved
in the production of spermatozoa, the question
has also been raised as to whether they may
also be capable of damaging male reproductive
DNA.
Drinks with sweeteners
Physical factors

 Climate
 Acclimatisation

 Heat stroke
Climate - description

Climate is the average and variations of

weather in a region over long periods
of time. Climate zones can be defined
using parameters such as
temperature and rainfall.
The climate of a given geographical is the average
of the various the weather conditions over a long
period of time, typically 30 years.
The climate's determination is carried out using
annual and monthly statistical measurements of
local atmospheric data such as :
 temperature,

 precipitations,

 sun exposure,

 Humidity,

 Wind's speed
 Classification of climate
According to the Köppen classification, the earth can be
divided into several major climatic zones and bands:
1. Tropical climate
2. Subtropical climate
3. Arid climate
4. Equatorial climate
5. Semiarid climate
6. Mediterranean climate
7. Temperate climate
8. Oceanic climate
9. Continental climate
10. Subarctic climate
11. Polar climate
12. Climate of Antarctica.
Climate influence to health:

3 types of climate:
1. Optimal;

2. Irritating;

3. With wide variations;

 Acclimatization

 Acclimatization is the process of an

organism adjusting to chronic change in its
environment, often involving temperature,
moisture, food, often relating to seasonal
climate changes.
Dry (arid and semiarid)
climates
 These climates are characterized by
dry and hot weather;
 In such conditions more water is
evaporated.
 Less liquid is excreted by kidney.
Deserts

 In hot deserts, high temperatures cause

rapid loss of water due to sweating, and the
absence of water sources with which to
replenish it can result in dehydration and
death within a few days. In addition,
unprotected humans are also at risk from
heatstroke.
 This climate is highly recommendable for
patiens with insufficient kidney function.
Heat stroke

 Heat loss mechanisms;

 Physiology;

 Symptoms;

 First aid;

 Prophylaxis
Heat loss mechanisms

1. 60 % - heat radiation;
2. 25 % - perspiration;
3. 10-12 % - convection;
4. 3 % - conductivity to surfaces.

(in standard conditions)

 Heat stroke – symptoms (1)

 Victims may become confused, may become

hostile, often experience headache, and may
seem intoxicated.
 Blood pressure may drop significantly from
dehydration, leading to possible fainting or
dizziness.
 Heart rate and respiration rate will increase
(tachycardia and tachypnea) as blood pressure
drops and the heart attempts to supply enough
oxygen to the body.
 Heat stroke – symptoms (2)
 The skin will become red as blood vessels dilate in an attempt to
increase heat dissipation. The decrease in blood pressure will
cause blood vessels to contract as heat stroke progresses,
resulting in a pale or bluish skin colour.
 Complaints of feeling hot may be followed by chills and
trembling, as is the case in fever. Some victims, especially young
children, may suffer convulsions.
 Acute dehydration such as that accompanying heat stroke can
produce nausea and vomiting; temporary blindness may also be
observed. Eventually, as body organs begin to fail,
unconsciousness and coma will result.
First aid
 The body temperature must be lowered
immediately. The victim should be moved to a
cool area and clothing removed to promote heat
loss.
 Hydration is of paramount importance in
cooling the victim. This is achieved by drinking
water (Oral rehydration). Intravenous hydration
(via a drip) is necessary if the victim is
confused, unconscious, or unable to tolerate
oral fluids.
 The victim's heart rate and breathing should be
monitored, and CPR may be necessary if the
victim goes into cardiac arrest.