Exposure to toluene can result in a nephropathy. This is one of the complications seen in people who abuse volatile inhalants (glue sniffing, paint sniffing).
Patient selection: exposure to toluene, often repeatedly
Metabolism of toluene results in generation of benzoic acid and hippuric acid (acid load).
This results in distal renal tubular injury or necrosis, resulting in acute and/or chronic kidney injury.
Laboratory findings include:
(1) metabolic acidosis with low blood pH
(2) normal or elevated serum anion gap
(3) hypokalemia (which may be severe enough to cause periodic paralysis)
(4) variable hyponatremia
(5) hypophosphatemia
(6) urine pH > 5.5
The abnormalities typically revert when exposure to toluene is stopped.
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