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Chronic low level trimethyltin exposure and the risk of developing nephrolithiasis
  1. Xiaojiang Tang1,2,
  2. Nanchun Li3,
  3. Lisha Kang1,
  4. Amber M Dubois4,
  5. Zhihong Gong5,
  6. Banghua Wu2,
  7. Guanchao Lai2,
  8. Aichu Yang2,
  9. Xiaoling Ruan2,
  10. Hongbin Gao2,
  11. Guanghua Zhu2,
  12. Yichen Ge2,5,
  13. Jinxin Zhang6,
  14. Zhongning Lin6,
  15. James R Olson4,5,
  16. Xuefeng Ren1,4,5
  1. 1Guangdong Medical Laboratory Animal Center, Foshan, Guangdong, China
  2. 2Guangdong Poison Control Center, Guangzhou, Guangdong, China
  3. 3Qingyuan Center for Disease Control and Prevention, Qingyuan, Guangdong, China
  4. 4Department of Pharmacology and Toxicology, The State University of New York, Buffalo, New York, USA
  5. 5Department of Social and Preventive Medicine, The State University of New York, Buffalo, New York, USA
  6. 6School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
  1. Correspondence to Dr Xuefeng Ren, 276 Farber Hall, Department of Social and Preventive Medicine, School of Public Health and Health Professions, The State University of New York, Buffalo, NY 14221, USA, xuefengr{at}; Professor Xiaojiang Tang, Guangdong Medical Laboratory Animal Center, Foshan 528248, Guangdong, China; river-t{at}


Objectives Nephrolithiasis (kidney stones) is a common disease with the prevalence that is increasing globally. We previously found that trimethyltin (TMT), a by-product of plastic stabilisers, can inhibit the H+/K+ ATPase activity in renal intercalated cells and alter urinary pH, which is a known risk factor for nephrolithiasis. In this study, we conducted a cross-sectional analysis to evaluate the impact of chronic low level occupational TMT exposure on nephrolithiasis.

Methods This study included 216 healthy workers with TMT exposure and 119 workers as controls with no TMT exposure. All study participants were administered a questionnaire and underwent a routine clinical examination including an ultrasonographic screening for kidney stones. Exposures were assessed by measuring TMT concentrations in personal air samples, blood and urine. Logistic regression analysis was used to estimate the ORs and 95% CIs for the risk of kidney stones.

Results TMT exposed workers had a higher prevalence of kidney stones (18.06%) in comparison with control workers (5.88%). High TMT concentrations in personal air samples, blood and urines were positively associated with increased prevalence of kidney stones in workers exposed to TMT compared with controls workers (p-trend values=0.005, 0.008 and 0.002, respectively). The length of employment in plants with elevated TMT levels (duration of the exposure) was significantly associated with the increased prevalence of kidney stones (p trend=0.001). The ORs were 2.66 for <3 years, 3.73 for 3–<10 years and 7.89 for 10+ years of employment compared with control workers.

Conclusions To our knowledge, this is the first report to demonstrate that occupational exposure to TMT is a potential risk factor for nephrolithiasis.

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