Toxic wastes and kidney disease: research needs.

In 1981 over one billion dollars will be spent sustaining the lives of patients with end-stage renal disease by hemodialysis and renal transplantation, but less than 0.02% of this amount will be invested in studies of nephrotoxicity (1). Any knowledge of the effect of industrial waste on human kidney disease gained from this miniscule effort will probably be serendipitous. Our monumental ignorance of this subject appears to have two sources. First, research on nephrotoxicity is largely confined to acute, high-dose exposure in animals; the delayed effects of chronic low-dose exposure in man remain virtually unexplored. Second, the etiology of most chronic kidney diseases in man is unknown. The diagnostic categories commonly used for end-stage renal diseases rarely stipulate underlying causes. Roughly 60% of dialysis and transplant patients