Nephrotoxic effects of mercury exposure and smoking among Egyptian workers in a fluorescent lamp factory

Impact of multi-heavy metal exposure on renal damage indicators in Korea: An analysis using Bayesian Kernel Machine Regression

Exposure to cadmium (Cd), arsenic (As), and mercury (Hg) is associated with renal tubular damage. People living near refineries are often exposed to multiple heavy metals at high concentrations. This cross-sectional study investigated the association between combined urinary Cd, As, and Hg levels and renal damage markers in 871 residents living near the Janghang refinery plant and in a control area. Urinary Cd, As, Hg, N-acetyl-β-D-glucosaminidase (NAG), and β2-microglobulin (β2-MG) levels were measured. The combined effects of Cd, As, and Hg on renal tubular damage markers were assessed using linear regression and a Bayesian Kernel Machine Regression (BKMR) model. The results of the BKMR model were compared using a stratified analysis of the exposure and control groups. While the linear regression showed that only Cd concentration was significantly associated with urinary NAG levels (β = 0.447, P value < .05), the BKMR model showed that Cd and Hg levels were also significantly associated with urinary NAG levels. The combined effect of the 3 heavy metals on urinary NAG levels was significant and stronger in the exposure group than in the control group. However, no relationship was observed between the exposure concentrations of the 3 heavy metals and urinary β2-MG levels. The results suggest that the BKMR model can be used to assess the health effects of heavy-metal exposure on vulnerable residents.

The Role of Oxidative Stress in Kidney Injury

Acute kidney injury and chronic kidney disease are among the most common non-communicable diseases in the developed world, with increasing prevalence. Patients with acute kidney injury are at an increased risk of developing chronic kidney disease. One of kidney injury's most common clinical sequelae is increased cardiovascular morbidity and mortality. In recent years, new insights into the pathophysiology of renal damage have been made. Oxidative stress is the imbalance favoring the increased generation of ROS and/or reduced body's innate antioxidant defense mechanisms and is of pivotal importance, not only in the development and progression of kidney disease but also in understanding the enhanced cardiovascular risk in these patients. This article summarizes and emphasizes the role of oxidative stress in acute kidney injury, various forms of chronic kidney disease, and also in patients on renal replacement therapy (hemodialysis, peritoneal dialysis, and after kidney transplant). Additionally, the role of oxidative stress in the development of drug-related nephrotoxicity and also in the development after exposure to various environmental and occupational pollutants is presented.

Nephrotoxic Biomarkers with Specific Indications for Metallic Pollutants: Implications for Environmental Health

Environmental and occupational exposure to heavy metals and metalloids is a major global health risk. The kidney is often a site of early damage. Nephrotoxicity is both a major consequence of heavy metal exposure and potentially an early warning of greater damage. A paradigm shift occurred at the beginning of the 21st century in the field of renal medicine. The medical model of kidney failure and treatment began to give way to a social model of risk factors and prevention with important implications for environmental health. This development threw into focus the need for better biomarkers: markers of exposure to known nephrotoxins; markers of early damage for diagnosis and prevention; markers of disease development for intervention and choice of therapy. Constituents of electronic waste, e-waste or e-pollution, such as cadmium (Cd), lead (Pb), mercury (HG), arsenic (As) and silica (SiO₂) are all potential nephrotoxins; they target the renal proximal tubules through distinct pathways. Different nephrotoxic biomarkers offer the possibility of identifying exposure to individual pollutants. In this review, a selection of prominent urinary markers of tubule damage is considered as potential tools for identifying environmental exposure to some key metallic pollutants.

Assessment of Lead and Mercury Exposure Levels in the General Population of Korea Using Integrated National Biomonitoring Data

In Korea, the estimated values of blood lead (Pb) and mercury (Hg) levels differ between two national-level biomonitors, namely the Korean National Environmental Health Survey and the Korea National Health and Nutrition Examination Survey. The present study used integrated data from these surveys to estimate the representative values of the change in concentration and recent distribution characteristics. The yearly trend of age-standardized exposure levels in regular adults was identified, and the geometric mean (GM) adjusted according to demographic characteristics was presented. Age-standardized GM for blood Pb and Hg in the integrated data was 2.06 and 3.64 μg/L in 2008, respectively, which decreased to 1.55 and 2.92 μg/L, respectively, by 2017. Adjusted GMs from most recently conducted surveys (2015-2017) were 1.61 and 2.98 μg/L for blood Pb and Hg, respectively. In particular, the adjusted percentage of blood Hg exceeding the reference value of 5 μg/L was 20.79%. While the blood Pb and Hg exposure levels are decreasing in Korea, the levels remain high relative to those in other countries. The Hg levels exceeded the reference value in many individuals. Therefore, continued biomonitoring must be conducted, and a reduction plan and exposure management are needed for harmful metals, including Hg.

Effect of mercury vapour exposure on urinary excretion of calcium, zinc and copper: relationship to alterations in functional and structural integrity of the kidney

Background: The kidney has a remarkable capacity to concentrate mercury (Hg) and as such is a primary target organ when exposure to Hg occurs, and it is also an organ for Hg excretion. Objective: The present work aims to investigate the effect of occupational Hg vapour exposure on the urinary excretion of calcium (Ca), zinc (Zn) and copper (Cu), and the possible association of this excretion to work duration as well as renal alterations. Methods: 83 non-smoker participants (36 referents, age: 35.69/9.5 years; 27 Hg vapour-exposed workers with 5/10 years work duration, age: 33.09/5.1 years; and 20 Hg vapour-exposed workers with]/11 years work duration, age: 39.509/8.50 years) were included in the present study. Urinary levels of microalbumin (U-Malb) and retinol-binding protein (U-RBP) as well as cytosolic glutathione S-transferase activity (U-GST) were measured to assess the glomerular and proximal tubular reabsorption functions as well as structural integrity of proximal tubules; respectively. In addition, blood Hg (B-Hg), serum levels of Hg (S-Hg) and Ca (S-Ca), and urinary levels of Hg (U-Hg), Ca (U-Ca), Zn (U-Zn), Cu (U-Cu) and creatinine (U-cr) were estimated. Results: In comparison to referents, all investigated parameters showed significant increase (except S-Ca and U-Zn/U-Cu ratio that significantly decreased among the workers as one group, S-Ca and U-Zn/U-Cu ratio that significantly and nonsignificantly decreased; respectively among workers with 5/10 years work duration, S-Ca and U-Zn/U-Cu ratio that significantly decreased among workers with]/11 years work duration). In addition, B-Hg was nonsignificantly increased and S-Ca was significantly decreased; also, both U-Hg and U-Zn/U-Cu were nonsignificantly decreased among workers with]/11 years work duration in comparison to those with 5/10 years work duration. Also, each of U-Hg, U-Ca, U-Zn and U-Cu was related to one another, while each of U-Ca, U-Zn and U-Cu was related to each of U-Malb, U-RBP and U-GST (except U-Zn was not related to U-GST). Conclusion: Hg vapour exposure leads to renal alterations which may parallel the change in proteinuria and enzymuria as well as the increased loss in urine of each of Ca, Zn and Cu. The urinary assessment of these metals may be used as a good indicator for renal dysfunction.

Hair mercury level in smokers and its influence on blood pressure and lipid metabolism

OBJECT

Smoking is a major risk factor for the development and progression of cardiovascular disease and cigarettes contain a slight amount of mercury. Mercury has been causally linked to cardiovascular diseases. This study evaluated the mercury content in hair according to smoking exposure status and the influence of the mercury level on blood pressure and lipid metabolism.

METHODS

We examined mercury concentration in the hair samples from 236 healthy people 16-75-years-of-age who had visited the health promotion center of a university hospital from January 2004 to January 2007. Self-reported cigarette smoking status and baseline health information were obtained using a questionnaire. Blood pressure and serum lipid level according to the mercury concentration were assessed.

RESULTS

The mean systolic blood pressure in the smoking exposure group and non-exposure group were 123.2±15.4mmHg and 117.2±15.9mmHg, respectively (p=0.005). The mean diastolic pressure in the smoking exposure group and non-exposed group were 80.2±10.9mmHg and 75.1±11.3mmHg, respectively (p<0.001). Mercury concentration had a positive relationship with systolic and diastolic blood pressure. Compared with the normal and high mercury groups, the normal mercury group demonstrated lower blood pressure, lower triglyceride, and lower smoking amount, but higher high density lipoprotein cholesterol than the high mercury group. There was an increase of mercury concentration in the smoking exposure group. The 20-29 packyear group showed significantly increased odds ratio of mercury content, compared with the non-exposure group (14.00, 95% confidence interval, 5.03-38.96).

CONCLUSIONS

Smoking is positively associated with mercury accumulation, and high mercury concentration is associated with increased blood pressure and abnormal lipid metabolism.

Impact of occupational exposure to elemental mercury on some antioxidative enzymes among dental staff

OBJECTIVES

The aim of this study is to investigate the effect of elemental mercury exposure on renal function and antioxidative enzymes activity as a possible mechanism of renal affection among dental staff.

METHODS

This study was performed on a group of dental staff exposed to elemental mercury (N = 32) and matched control group (N = 37). Urinary and blood level of mercury, albumin α1 microgloblin in urine, glutathione peroxidase and superoxide dismutase blood level were measured for the exposed and control group.

RESULTS

Compared to the control group, urinary and blood mercury were significantly higher in the exposed group. Glutathione peroxidase and superoxide dismutase activities in blood were significantly decreased and were negatively correlated with duration of work.

CONCLUSION

Oxidative stress is an important molecular mechanism for renal dysfunction in mercury exposure, manifested by decreased activities of antioxidant enzymes.

Variability of mercury in urine among Mexican women residing in a mining area

OBJECTIVE

To know the variability of the creatinine-adjusted inorganic mercury (HgUCr) levels in women aged >or=12 years to evaluate the impact of residing at a site contaminated by mercury in soil.

METHODS

A cross-sectional epidemiologic study was conducted, in which 122 women participated, in whom, HgUCr was determined. Simultaneously, a questionnaire was applied for evaluate the different factors of mercury exposure, sociodemographic characteristics, and dietary hygiene measures. The environmental exposures were evaluated by measure Hg in soil and mining dumps.

RESULTS

Women aged >30 years residing in areas contaminated by Hg in soil (>625 ppb) had 212% more HgUCr than the women who living in areas least contaminated, while women with amalgam dental fillings had 120% more HgUCr than women without these.

CONCLUSION

In conclusion, exposure to different physicochemical forms of Hg by environmental mechanisms and factors intrinsic to the women are probably responsible for HgUCr-level variability in the women.

Mercury exposures and symptoms in smelting workers of artisanal mercury mines in Wuchuan, Guizhou, China

Mercury exposures to smelting workers of artisanal mercury mines in Wuchuan, Guizhou, China were evaluated by urine and hair mercury survey. The mean urinary mercury (U-Hg), hair total mercury (T-Hg), and hair methyl mercury (Me-Hg) for smelting workers was 1060 microg/g creatinine (microg/g Cr), 69.3 and 2.32 microg/g, respectively. The results were significantly higher than that of control group, which is 1.30 microg/g Cr, 0.78 and 0.65 microg/g, correspondingly. The average urinary beta2-microglobulin (beta2-MG) was 248 microg/g Cr for the exposed group contrasting to 73.5 microg/g Cr for the control group and the data showed a serious adverse effect on renal system for the smelting workers. The workers were exposed to mercury vapor through inhalation, and the exposure route of Me-Hg may be through intake of polluted diet. The results indicate that age, alcohol drinking, and smoking are not crucial factors controlling the urine and hair mercury levels for the exposed and the control group. Clinical symptoms including finger and eyelid tremor, gingivitis, and typical dark-line on gums were observed in six workers. This study indicated that the smelting workers in Wuchuan were seriously exposed to mercury vapor.

Smoking: a risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients--absence of evidence or evidence of absence?

Although it is beyond any doubt that smoking is the number one preventable cause of death in most countries, smoking as an independent progression factor in renal disease has been questioned against the background of evidence-based criteria. This is because information from large, randomized, prospective studies that investigate the effects of smoking on renal function in healthy individuals as well as in patients with primary or secondary renal disease are lacking. Since 2003, a substantial number of clinical and experimental data concerning the adverse renal effects of smoking have been published, including large, prospective, population-based, observational studies. These more recent data together with evidence from experimental studies clearly indicate that smoking is a relevant risk factor, conferring a substantial increase in risk for renal function deterioration. This review summarizes the present knowledge about the renal risks of smoking as well as the increased cardiovascular risk caused by smoking in patients with chronic kidney disease. The conclusion is that smoking is an important renal risk factor, and nephrologists have to invest more efforts to motivate patients to stop smoking.

Subclinical nephrotoxicity caused by smoking and occupational silica exposure among Egyptian industrial workers

BACKGROUND

The aim of the present work was to investigate early signs of subclinical renal alterations due to silica exposure and smoking among non-silicotics and silicotics by measuring urinary indicators of nephrotoxicity.

METHODS

The subjects comprised 29 non-silicotics (9 non-smokers, 20 smokers), 24 silicotics (9 non-smokers, 15 smokers), and 28 referents (9 non-smokers, 19 smokers). Measured urinary parameters were concentrations of total protein, microalbumin, retinol-binding protein, and activities of N-acetyl-beta-D-glucosaminidase and glutathione S-transferase. In addition, we measured levels of urinary silicon and creatinine.

RESULTS

Compared with referents, both non-silicotics and silicotics excreted significant high levels of all measured parameters. Smokers in each investigated group also showed increased levels (although not significant) of renal parameters in comparison to corresponding non-smokers. Among non-silicotics, the present results showed that elevation of measured urinary parameters was significantly associated with work duration, while only urinary excretion of glutathione S-transferase was associated with work duration among silicotics.

CONCLUSIONS

The study confirms that silica may lead to subclinical signs of nephrotoxicity, and that smoking also has a nephrotoxic effect on kidney and is synergistic to nephrotoxicity of silica exposure. Additionally, the study suggests that renal alterations may occur prior to pulmonary involvement.