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Occupational Exposure to Silica and End-stage Renal Disease-Reply

Geoffrey M. Calvert, MD, MPH; Kyle Steenland, PhD
JAMA. 1997;278(7):547. doi:10.1001/jama.1997.03550070039025.
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We agree with Dr Wilke that the pathogenesis for the increased risk of ESRD caused by glomerulonephritis among silica-exposed gold miners is unclear. In our article, we described the competing theories of pathogenesis, ie, immunologic injury vs direct toxic effect of silica. Our intent was to give equal attention to these 2 theories. As is the case with silicosis, evidence of immunologic injury has been observed in some, but not all, silica-exposed patients with renal injury.1

Therefore, different mechanisms of toxicity may be operating in different patients. In patients with evidence of immunologic abnormality, it is not clear if these abnormalities are directly responsible for renal injury or if they are a response to the direct toxic effect of silica. It is worth noting that there is evidence linking silica exposure to a broad range of autoimmune diseases.2

One factor responsible for the variability in the mechanism of


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