Nephrol Dial Transplant (1999) 14: 2813-2815
© 1999 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
p-Cresol: a toxin revealing many neglected but relevant aspects of uraemic toxicity
Nephrology Unit, Department of Intenal Medicine, University Hospital, Gent, Belgium
Correspondence and offprint requests to: R. Vanholder, Nephrology Unit, Department of Intenal Medicine, University Hospital, De Pintelaan 185, B-9000 Gent, Belgium.
Introduction
p-Cresol (4-methylphenol), a 108.1 Da volatile low-molecular-weight compound, is a member of the large family of the phenoles. It is a partially lipophilic moiety which strongly binds to plasma protein (close to 100%) under normal conditions. p-Cresol is metabolized through conjugation, mainly sulphation and glucuronization [1,2], but removal of the unconjugated p-cresol is, at least in part, via the urine [3]. Therefore it is not surprising that this compound, together with several other phenoles, is retained when the kidneys fail [4,5].
Generation
P-Cresol is an end-product of protein breakdown, and an increase of the nutritional protein load in healthy individuals results in enhanced generation and urinary excretion [3]. The serum p-cresol concentration in uraemic patients can be decreased by changing to a low-protein
Uraemic plasma concentrations
Toxicity
Dialytic removal
Potential alternative removal methods
Conclusions
References
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