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      Acute Kidney Injury following Exposure to Formaldehyde-Free Hair-Straightening Products


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          Formaldehyde-free hair-straightening products are hair-smoothening solutions widely used by professional beauty salons. Formaldehyde-free hair straighteners do not technically contain formaldehyde; however, they contain other chemicals such as glyoxyloyl carbocysteine which releases formaldehyde upon contact with heat. Moreover, its by-product glyoxylate may convert to oxalate; both compounds have potential nephrotoxic effect. Here, we report a case of a 41-year-old woman who presented to the emergency room with weakness, nausea, vomiting, and stage 3 acute kidney injury (AKI) according to Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury staging shortly after exposure to formaldehyde-free hair-straightening product; other causes of AKI were excluded such as preceding acute illness, drug history, or other nephrotoxic agent exposure. On physical examination, the patient was pale, and her vital signs were normal. The urine microscopy and serologic workup were not indicative. Kidney core biopsy revealed interstitial edema, acute interstitial nephritis, and oxalate crystal nephropathy. Kidney function completely recovered after a short course of steroid therapy. In this case, AKI was a complication caused by exposure to hair-straightening products branded as formaldehyde free but actually containing other chemical products which release formaldehyde and other toxic chemicals when heated during the straightening procedure and may cause systemic toxicity, particularly kidney injury. Different cosmetic products are widely in use, but not all are under tight regulation, and therefore, it is important to raise the awareness among both medical teams and consumers of possible adverse health effects of different cosmetic products.

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          Most cited references16

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          Nephrotoxicity and Kidney Transport Assessment on 3D Perfused Proximal Tubules.

          Proximal tubules in the kidney play a crucial role in reabsorbing and eliminating substrates from the body into the urine, leading to high local concentrations of xenobiotics. This makes the proximal tubule a major target for drug toxicity that needs to be evaluated during the drug development process. Here, we describe an advanced in vitro model consisting of fully polarized renal proximal tubular epithelial cells cultured in a microfluidic system. Up to 40 leak-tight tubules were cultured on this platform that provides access to the basolateral as well as the apical side of the epithelial cells. Exposure to the nephrotoxicant cisplatin caused a dose-dependent disruption of the epithelial barrier, a decrease in viability, an increase in effluent LDH activity, and changes in expression of tight-junction marker zona-occludence 1, actin, and DNA-damage marker H2A.X, as detected by immunostaining. Activity and inhibition of the efflux pumps P-glycoprotein (P-gp) and multidrug resistance protein (MRP) were demonstrated using fluorescence-based transporter assays. In addition, the transepithelial transport function from the basolateral to the apical side of the proximal tubule was studied. The apparent permeability of the fluorescent P-gp substrate rhodamine 123 was decreased by 35% by co-incubation with cyclosporin A. Furthermore, the activity of the glucose transporter SGLT2 was demonstrated using the fluorescent glucose analog 6-NBDG which was sensitive to inhibition by phlorizin. Our results demonstrate that we developed a functional 3D perfused proximal tubule model with advanced renal epithelial characteristics that can be used for drug screening studies.
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            Drug-induced nephropathy: an update.

            Medications cause renal disease by promoting various types of injury in the kidney. Several drugs reduce renal perfusion and cause prerenal azotemia. Vascular disease can develop following exposure to various medications through direct and indirect effects. A number of glomerular lesions have been described with therapeutic agents and illicit drugs. Acute interstitial nephritis occurs from a drug-induced allergic reaction, which promotes interstitial inflammation and tubular damage. Acute tubular necrosis is a dose-dependent process that occurs from direct drug toxicity on tubular epithelia. Other less common patterns of drug-induced tubular injury include osmotic nephropathy, crystal nephropathy and acute nephrocalcinosis. Finally, postrenal azotemia from structural or functional obstruction of the urinary tract also complicates therapy with a number of medications.
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              Characterization of formaldehyde exposure resulting from the use of four professional hair straightening products.

              An exposure simulation study was conducted to characterize potential formaldehyde exposures of salon workers and clients during keratin hair smoothing treatments. Four different hair treatment brands (Brazilian Blowout, Coppola, Global Keratin, and La Brasiliana) were applied to separate human hair wigs mounted on mannequin heads. Short-term (6-16 min) and long-term (41-371 min) personal and area samples (at distances of 0.5 to 3.0 m from the source) were collected during each treatment for the 1-day simulation. A total of 88 personal, area, and clearance samples were collected. Results were analyzed based on task sampling (blow-dry, flat-iron), treatment sampling (per hair product), and time-weighted averages (per hair treatment, four consecutive treatments). Real-time monitoring of tracer gas levels, for determining the air exchange rate, and formaldehyde levels were logged throughout the simulation. Bulk samples of each hair treatment were collected to identify and quantify formaldehyde and other chemical components that may degrade to formaldehyde under excessive heat. Mean airborne concentrations of formaldehyde ranged from 0.08-3.47 ppm during blow-dry and 0.08-1.05 ppm during flat-iron. During each treatment, the mean airborne concentrations ranged from 0.02-1.19 ppm throughout different zones of the salon. Estimated 8-hr time-weighted averages for one treatment per day ranged from 0.02 ppm for La Brasiliana to 0.08-0.16 ppm for Brazilian Blowout. For four treatments per day, means ranged from 0.04-0.05 ppm for La Brasiliana to 0.44-0.75 ppm for Brazilian Blowout. Using all four products in one day resulted in estimated 8-hr time-weighted averages ranging from 0.17-0.29 ppm. Results from bulk sampling reported formaldehyde concentrations of 11.5% in Brazilian Blowout, 8.3% in Global Keratin, 3% in Coppola, and 0% in La Brasiliana. Other products that degrade into formaldehyde were detected in Global Keratin, Coppola, and La Brasiliana. The results of this study show that professional hair smoothing treatments--even those labeled "formaldehyde-free"--have the potential to produce formaldehyde concentrations that meet or exceed current occupational exposure limits.

                Author and article information

                Case Reports in Nephrology and Dialysis
                S. Karger AG
                May -August 2022
                11 July 2022
                : 12
                : 2
                : 112-116
                [_a] aInstitute of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan, Israel
                [_b] bSackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
                525567 PMC9386411 Case Rep Nephrol Dial 2022;12:112–116
                © 2022 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.

                : 23 January 2022
                : 15 May 2022
                Page count
                Figures: 2, Pages: 5
                No funding was obtained for this study.
                Single Case

                Cardiovascular Medicine,Nephrology
                Cosmetic products,Acute interstitial nephritis,Acute kidney injury,Crystal nephropathy


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