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Carretero VJ, Liccardi N, Tejedor MA, de Pascual R, Campano JH, Hernández-Guijo JM. Lead exerts a depression of neurotransmitter release through a blockade of voltage dependent calcium channels in chromaffin cells. Toxicology 2024; 505:153809. [PMID: 38648961 DOI: 10.1016/j.tox.2024.153809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
The present work, using chromaffin cells of bovine adrenal medullae (BCCs), aims to describe what type of ionic current alterations induced by lead (Pb2+) underlies its effects reported on synaptic transmission. We observed that the acute application of Pb2+ lead to a drastic depression of neurotransmitters release in a concentration-dependent manner when the cells were stimulated with both K+ or acetylcholine, with an IC50 of 119,57 μM and of 5,19 μM, respectively. This effect was fully recovered after washout. Pb2+ also blocked calcium channels of BCCs in a time- and concentration-dependent manner with an IC50 of 6,87 μM. This blockade was partially reversed upon washout. This compound inhibited the calcium current at all test potentials and shows a shift of the I-V curve to more negative values of about 8 mV. The sodium current was not blocked by acute application of high Pb2+ concentrations. Voltage-dependent potassium current was also shortly affected by high Pb2+. Nevertheless, the calcium- and voltage-dependent potassium current was drastically depressed in a dose-dependent manner, with an IC50 of 24,49 μM. This blockade was related to the prevention of Ca2+ influx through voltage-dependent calcium channels coupled to Ca2+-activated K+-channels (BK) instead a direct linking to these channels. Under current-clamp conditions, BCCs exhibit a resting potential of -52.7 mV, firing spontaneous APs (1-2 spikes/s) generated by the opening of Na+ and Ca2+-channels, and terminated by the activation of K+ channels. In spite of the effect on ionic channels exerted by Pb2+, we found that Pb2+ didn't alter cellular excitability, no modification of the membrane potential, and no effect on action potential firing. Taken together, these results point to a neurotoxic action evoked by Pb2+ that is associated with changes in neurotransmitter release by blocking the ionic currents responsible for the calcium influx.
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Affiliation(s)
- Victoria Jiménez Carretero
- Department of Pharmacology and Therapeutic, Facultad de Medicina, Univ. Autónoma de Madrid, Av. Arzobispo Morcillo 4, Madrid 28029, Spain
| | - Ninfa Liccardi
- Department of Pharmacology and Therapeutic, Facultad de Medicina, Univ. Autónoma de Madrid, Av. Arzobispo Morcillo 4, Madrid 28029, Spain
| | - Maria Arribas Tejedor
- Department of Pharmacology and Therapeutic, Facultad de Medicina, Univ. Autónoma de Madrid, Av. Arzobispo Morcillo 4, Madrid 28029, Spain
| | - Ricardo de Pascual
- Department of Pharmacology and Therapeutic, Facultad de Medicina, Univ. Autónoma de Madrid, Av. Arzobispo Morcillo 4, Madrid 28029, Spain
| | - Jorge Hernández Campano
- Department of Pharmacology and Therapeutic, Facultad de Medicina, Univ. Autónoma de Madrid, Av. Arzobispo Morcillo 4, Madrid 28029, Spain
| | - Jesús M Hernández-Guijo
- Department of Pharmacology and Therapeutic, Facultad de Medicina, Univ. Autónoma de Madrid, Av. Arzobispo Morcillo 4, Madrid 28029, Spain; Ramón y Cajal Institute for Health Research, IRYCIS, Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, Km. 9,100, Madrid 28029, Spain.
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Wen Y, Vechetti IJ, Leng D, Alimov AP, Valentino TR, Zhang XD, McCarthy JJ, Peterson CA. Early transcriptomic signatures and biomarkers of renal damage due to prolonged exposure to embedded metal. Cell Biol Toxicol 2023; 39:2861-2880. [PMID: 37058270 DOI: 10.1007/s10565-023-09806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 03/24/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Prolonged exposure to toxic heavy metals leads to deleterious health outcomes including kidney injury. Metal exposure occurs through both environmental pathways including contamination of drinking water sources and from occupational hazards, including the military-unique risks from battlefield injuries resulting in retained metal fragments from bullets and blast debris. One of the key challenges to mitigate health effects in these scenarios is to detect early insult to target organs, such as the kidney, before irreversible damage occurs. METHODS High-throughput transcriptomics (HTT) has been recently demonstrated to have high sensitivity and specificity as a rapid and cost-effective assay for detecting tissue toxicity. To better understand the molecular signature of early kidney damage, we performed RNA sequencing (RNA-seq) on renal tissue using a rat model of soft tissue-embedded metal exposure. We then performed small RNA-seq analysis on serum samples from the same animals to identify potential miRNA biomarkers of kidney damage. RESULTS We found that metals, especially lead and depleted uranium, induce oxidative damage that mainly cause dysregulated mitochondrial gene expression. Utilizing publicly available single-cell RNA-seq datasets, we demonstrate that deep learning-based cell type decomposition effectively identified cells within the kidney that were affected by metal exposure. By combining random forest feature selection and statistical methods, we further identify miRNA-423 as a promising early systemic marker of kidney injury. CONCLUSION Our data suggest that combining HTT and deep learning is a promising approach for identifying cell injury in kidney tissue. We propose miRNA-423 as a potential serum biomarker for early detection of kidney injury.
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Affiliation(s)
- Yuan Wen
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA.
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA.
| | - Ivan J Vechetti
- Department of Nutrition and Health Sciences, College of Education and Human Sciences, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Dongliang Leng
- Faculty of Health Sciences, CRDA, University of Macau, Taipa, Macau, China
| | - Alexander P Alimov
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Taylor R Valentino
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Xiaohua D Zhang
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - John J McCarthy
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Charlotte A Peterson
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
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Desai G, Niu Z, Luo W, Frndak S, Shaver AL, Kordas K. Low-level exposure to lead, mercury, arsenic, and cadmium, and blood pressure among 8-17-year-old participants of the 2009-2016 National Health and Nutrition Examination Survey. ENVIRONMENTAL RESEARCH 2021; 197:111086. [PMID: 33781774 PMCID: PMC8211235 DOI: 10.1016/j.envres.2021.111086] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/14/2021] [Accepted: 03/23/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Dysregulation of systolic, diastolic blood pressure (SBP, DBP), and pulse pressure (PP) in children may predict elevated blood pressure (BP) in adulthood. Toxicant exposure is widely studied as a risk factor for high BP in adults, but not in children. We assessed the joint associations between lead (Pb), mercury (Hg), arsenic (As), and cadmium (Cd) exposure and SBP, DBP, and PP among 8-17 year-old participants (n = 1642) of the 2009-2016 National Health and Nutrition Examination Survey (NHANES). METHODS Participants with at least two BP measures were included. Urinary As and Cd were adjusted for urinary creatinine concentrations. Blood Pb, Hg, and urinary As, Cd were natural log-transformed. Bayesian Kernel Machine Regression (BKMR) analyses were conducted to assess the associations between the toxicant mixture and BP measures. Multivariable regression models assessed the associations between individual toxicants, and the four toxicants simultaneously with each of the outcomes. Interactions with sodium intake were tested. RESULTS Exposure to all toxicants was low, with median (5%, 95%) level: Pb, 0.57 (0.26, 1.60) μg/dL; Hg, 0.37 (0.19, 2.12) μg/L; As, 5.61 (1.37, 33.2) μg/g creatinine, Cd, 0.06 (0.03, 0.23) μg/g creatinine. Toxicant mixture showed a statistically significant, inverse association with DBP, but not other BP measures. Linear regressions revealed no association between toxicants, individually or together, and BP measures. No evidence of interaction of sodium intake with any of the toxicants was observed. CONCLUSIONS In a nationally representative sample of 8-17 year-olds, we found suggestive inverse association of the mixture of low-level Pb, Hg, As, and Cd, with DBP. Longitudinal studies with multiple toxicants are needed to understand the interactive effects of toxicants on children's BP.
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Affiliation(s)
- Gauri Desai
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, USA.
| | - Zhongzheng Niu
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, USA
| | - Wei Luo
- Department of Sociology, University at Buffalo, The State University of New York, USA
| | - Seth Frndak
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, USA
| | - Amy L Shaver
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, USA
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Jalili C, Kazemi M, Cheng H, Mohammadi H, Babaei A, Taheri E, Moradi S. Associations between exposure to heavy metals and the risk of chronic kidney disease: a systematic review and meta-analysis. Crit Rev Toxicol 2021; 51:165-182. [PMID: 33960873 DOI: 10.1080/10408444.2021.1891196] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We performed a systematic review and meta-analysis to examine the relationship between heavy metals (HMs) exposure and the risk of chronic kidney disease (CKD). Databases of Web of Science, Embase, MEDLINE, and Scopus were searched through June 2020 to identify studies assessing the relationships between exposure to HMs (i.e. cadmium, lead, arsenic, mercury) and the risk of CKD, evaluated by decreased estimated glomerular filtration rate (eGFR) and/or increased proteinuria risks in adults (≥18 years). Data were pooled by random-effects models and expressed as weighted mean differences and 95% confidence intervals. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). Twenty-eight eligible articles (n = 107,539 participants) were included. Unlike eGFR risk (p = 0.10), Cadmium exposure was associated with an increased proteinuria risk (OR = 1.35; 95% CI: 1.13, 1.61; p < 0.001; I2 = 79.7%). Lead exposure was associated with decreased eGFR (OR = 1.12; 95%CI: 1.03, 1.22; p = 0.008; I2 = 87.8%) and increased proteinuria (OR = 1.25; 95% CI: 1.04, 1.49; p = 0.02; I2 = 79.6) risks. Further, arsenic exposure was linked to a decreased eGFR risk (OR = 1.55; 95% CI: 1.05, 2.28; p = 0.03; I2 = 89.1%) in contrast to mercury exposure (p = 0.89). Only two studies reported the link between arsenic exposure and proteinuria risk, while no study reported the link between mercury exposure and proteinuria risk. Exposure to cadmium, lead, and arsenic may increase CKD risk in adults, albeit studies were heterogeneous, warranting further investigations. Our observations support the consideration of these associations for preventative, diagnostic, monitoring, and management practices of CKD.
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Affiliation(s)
- Cyrus Jalili
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Kazemi
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, New York, USA
| | - Hefa Cheng
- MOE Key Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefeh Babaei
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ensiyeh Taheri
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sajjad Moradi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,Halal Research Center of IRI, FDA, Tehran, Iran
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Chung CJ, Wu CD, Hwang BF, Wu CC, Huang PH, Ho CT, Hsu HT. Effects of ambient PM 2.5 and particle-bound metals on the healthy residents living near an electric arc furnace: A community- based study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 728:138799. [PMID: 32361581 DOI: 10.1016/j.scitotenv.2020.138799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/27/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
Fine particulate matter (PM2.5) emitted from electric arc furnaces (EAFs) poses health concerns. However, little research has been done on the impact of EAF on the health of community residents. This cross-sectional study conducted a PM2.5 exposure assessment and health examination of community residents living near an EAF. A total of 965 residents aged 40-90 years were recruited. The residents' exposure to PM2.5 was categorized according to the distance of their residence from the EAFs (<500, 500-1000, 1000-1500, 1500-2000, and > 2000 m). Average ambient PM2.5 concentrations were estimated using a hybrid kriging/land-use regression (LUR) model. In addition, we selected two air-sampling sites to monitor the 2-year levels of PM2.5 and particle-bound metals. A spot urine sample and blood samples were collected and ten heavy metal concentrations in the blood were analyzed. Inflammation- and oxidative stress-related biomarkers were measured. The associations between environmental factors and a biochemical examination were estimated using a generalized linear model. Active air sampling and hybrid kriging/LUR model simulation indicated increased levels of PM2.5 near the EAF. The metal concentrations in PM2.5 included Fe, Pb, Mn, Ni, As, Cu, Ni, Zn, and Al, which also significantly increased near the EAF. PM2.5 levels were significantly associated with an increased total cholesterol-high-density lipoprotein (TC/HDL) ratio. High levels of PM2.5 and malondialdehyde were associated with a 1.72-fold increased risk of TC/HDL ratio ≥ 4 (95% CI: 1.12-2.65) after adjusting for potential confounding factors. Blood Pb levels were significantly associated with increased systolic and diastolic blood pressure and decreased estimated glomerular filtration rate but negatively associated with distance from the EAF. The results show that people living near EAFs should pay more attention to adverse health problems, including atherogenic dyslipidemia, hypertension, and chronic kidney disease associated with exposure to PM2.5 and particle-bound metals.
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Affiliation(s)
- Chi-Jung Chung
- Department of Public Health, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Da Wu
- Department of Geomatics, National Cheng Kung University, Tainan, Taiwan; Adjunct Assistant Research Fellow, National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Bing-Fang Hwang
- Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan
| | - Chin-Ching Wu
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Ping-Hsuan Huang
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chih-Te Ho
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hui-Tsung Hsu
- Department of Public Health, China Medical University, Taichung, Taiwan.
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6
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Ahmed F, Tscharke B, O'Brien J, Thompson J, Samanipour S, Choi P, Li J, Mueller JF, Thomas K. Wastewater-based estimation of the prevalence of gout in Australia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 715:136925. [PMID: 32007890 DOI: 10.1016/j.scitotenv.2020.136925] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 06/10/2023]
Abstract
Allopurinol, a first-line gout treatment drug in Australia, was assessed as a wastewater-based epidemiology biomarker of gout via quantification of the urinary metabolite, oxypurinol in wastewater. The in-sewer stability of oxypurinol was examined using laboratory-scale sewer reactors. Wastewater from 75 wastewater treatment plants across Australia, covering approximately 52% (12.2 million) of the country's population, was collected on the 2016 census day. Oxypurinol was quantified in the wastewater samples and population-weighted mass loads calculated. Pearson and Spearman rank-order correlations were applied to investigate any link between allopurinol, other selected wastewater biomarkers, and socio-economic indicators. Oxypurinol was shown to be stable in sewer conditions and suitable as a WBE biomarker. Oxypurinol was detected in all wastewater samples. The estimated consumption of allopurinol ranged from 1.9 to 32 g/day/1000 people equating to 4.8 to 80 DDD/day/1000 people. The prevalence of gout across all tested sewer catchments was between 0.5% to 8%, with a median of 2.9% nationally. No significant positive correlation was observed between allopurinol consumption and alcohol consumption, mean age of catchment population, remoteness or higher socioeconomic status. There was a significant positive correlation with selective analgesic drug use. Wastewater analysis can be used to study gout prevalence and can provide additional insights on population level risk factors when triangulated with other biomarkers.
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Affiliation(s)
- Fahad Ahmed
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia.
| | - Benjamin Tscharke
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Jake O'Brien
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Jack Thompson
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Saer Samanipour
- Norwegian Institute for Water Research (NIVA), 0349 Oslo, Norway
| | - Phil Choi
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Jiaying Li
- Advanced Water Management Centre (AWMC), The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Jochen F Mueller
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Kevin Thomas
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
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Mujaj B, Yang WY, Zhang ZY, Wei FF, Thijs L, Verhamme P, Staessen JA. Renal function in relation to low-level environmental lead exposure. Nephrol Dial Transplant 2020; 34:941-946. [PMID: 30165570 PMCID: PMC6545464 DOI: 10.1093/ndt/gfy279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Numerous studies suggested that occupational or environmental exposure to lead adversely affects renal function. However, most studies lost relevance because of the substantially lower current environmental lead exposure and all relied on serum creatinine to estimate glomerular filtration. We investigated the association of estimated glomerular filtration rate (eGFR), estimated from serum creatinine, cystatin C or both, with blood lead (BPb) using the baseline measurements of the ongoing Study for Promotion of Health in Recycling Lead (SPHERL; NCT02243904) in newly hired workers prior to significant occupational lead exposure. METHODS Among 447 men (participation rate, 82.7%), we assessed the association of eGFR and the urinary albumin-to-creatinine ratio (ACR) with BPb across thirds of the BPb distribution using linear regression analysis. Fully adjusted models accounted for age, blood pressure, body mass index, the waist-to-hip ratio, smoking, the total-to-high-density-lipoprotein ratio, plasma glucose, serum γ-glutamyltransferase and antihypertensive drug treatment. RESULTS Age averaged 28.7 (SD, 10.2) years (range, 19.1-31.8). Geometric mean BPb concentration was 4.34 μg/dL (5th-95th percentile interval, 0.9-14.8). In unadjusted and adjusted analyses, eGFR estimated from serum creatinine [mean (SD), 105.26 (15.2) mL/min/1.73 m2], serum cystatin C [mean (SD), 127.8 (13.8) mL/min/1.73 m2] or both [mean (SD), 111.9 (14.8) mL/min/1.73 m2] was not associated with BPb (P ≥ 0.36), whereas ACR [geometric mean, 4.32 mg/g (5th-95th percentile interval, 1.91-12.50)] was lower with higher BPb. CONCLUSIONS At the BPb levels observed in this study, there was no evidence for an association between renal function and lead exposure.
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Affiliation(s)
- Blerim Mujaj
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Institut Universitaire de Médicine Sociale et Préventive, University of Lausanne, Lausanne, Switzerland
| | - Fang-Fei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Peter Verhamme
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Zhou R, Xu Y, Shen J, Han L, Chen X, Feng X, Kuang X. Urinary KIM-1: a novel biomarker for evaluation of occupational exposure to lead. Sci Rep 2016; 6:38930. [PMID: 27966578 PMCID: PMC5155212 DOI: 10.1038/srep38930] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/15/2016] [Indexed: 11/23/2022] Open
Abstract
Chronic occult lead poisoning often develops ensuing occupational lead exposure. Early diagnosis of lead poisoning is critical for timely discontinuation of lead exposure and for prognosis. This study explored the value of urinary kidney injury molecule-1 (KIM-1) in diagnosing renal injury induced by lead at an early stage. We retrospectively analyzed 92 workers exposed to occupational lead and demonstrated a better correlation ship between blood lead levels and urine excretion of KIM-1 than other traditional renal injury biomarkers following creatinine adjustment. Receiver operating characteristic curve analysis of the ability of diverse biomarkers for predicting kidney injury in lead-exposed workers demonstrated that the order of predicting accuracy of the studied biomarkers is as follows: urinary KIM-1-to-creatinine ratio > urinary N-acetyl-β-(D)-glucosaminidase-to-creatinine ratio > urinary β2-microglobulin-to-creatinine ratio > urinary α1-microglobulin-to-creatinine ratio, with the Youden index being 16.59 ng/g, 14.01 U/g, 0.15 mg/g, and 4.63 mg/g, respectively. Collectively, our findings suggest that short-period occupational lead exposure may cause injury of renal tubules. Urinary excretion of KIM-1 correlates with blood lead levels better than other traditional renal injury biomarkers, including N-acetyl-β-(D)-glucosaminidase, α1-microglobulin, and β2-microglobulin. Longitudinal surveillance of urinary KIM-1 may aid for early diagnosis of renal tubular injury in workers with occupational lead exposure.
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Affiliation(s)
- Rong Zhou
- Department of Nephrology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yahong Xu
- Department of Nephrology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jie Shen
- Department of Nephrology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lin Han
- Department of Nephrology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xi Chen
- Department of Nephrology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuefang Feng
- Department of Nephrology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xingya Kuang
- Department of Occupational medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
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9
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Batuman V, Wedeen RP. The Persistence of Chronic Lead Nephropathy. Am J Kidney Dis 2014; 64:1-3. [DOI: 10.1053/j.ajkd.2014.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/10/2014] [Indexed: 11/11/2022]
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Environmental lead exposure accelerates progressive diabetic nephropathy in type II diabetic patients. BIOMED RESEARCH INTERNATIONAL 2013; 2013:742545. [PMID: 23555094 PMCID: PMC3600262 DOI: 10.1155/2013/742545] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/24/2013] [Indexed: 11/18/2022]
Abstract
Whether environmental lead exposure has a long-term effect on progressive diabetic nephropathy in type II diabetic patients remains unclear. A total of 107 type II diabetic patients with stage 3 diabetic nephropathy (estimated glomerular filtration rate (eGFR) range, 30-60 mL/min/1.73 m(2)) with normal body lead burden (BLB) (<600 μ g/72 hr in EDTA mobilization tests) and no history of exposure to lead were prospectively followed for 2 years. Patients were divided into high-normal BLB (>80 μ g) and low-normal BLB (<80 μ g) groups. The primary outcome was a 2-fold increase in the initial creatinine levels, long-term dialysis, or death. The secondary outcome was a change in eGFR over time. Forty-five patients reached the primary outcome within 2 years. Although there were no differences in baseline data and renal function, progressive nephropathy was slower in the low-normal BLB group than that in the high-normal BLB group. During the study period, we demonstrated that each 100 μ g increment in BLB and each 10 μ g increment in blood lead levels could decrease GFR by 2.2 mL/min/1.72 m(2) and 3.0 mL/min/1.72 m(2) (P = 0.005), respectively, as estimated by generalized equations. Moreover, BLB was associated with increased risk of achieving primary outcome. Environmental exposure to lead may have a long-term effect on progressive diabetic nephropathy in type II diabetic patients.
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11
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Roberts DM, Singer RF. Lead mobilization study and the clearance of intravenous CaNa2EDTA in a patient with end-stage renal failure on hemodialysis. J Clin Pharmacol 2011; 52:110-3. [PMID: 21415282 DOI: 10.1177/0091270010393345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Darren M Roberts
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Victoria Street, Darlinghurst, NSW, 2010 Australia.
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12
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Onuegbu AJ, Olisekodiaka MJ, Nwaba EI, Adeyeye AD, Akinola FFS. Assessment of some renal indices in people occupationally exposed to lead. Toxicol Ind Health 2011; 27:475-9. [PMID: 21310779 DOI: 10.1177/0748233710390020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Exposure to lead has been reported to have adverse health implications. An assessment of renal function in people occupationally exposed to lead was carried out using the following biochemical markers urea, creatinine, sodium, potassium, chloride and bicarbonate. A total of 53 test subjects (mean age 30.9 ± 7.7) were randomly selected among some workers occupationally exposed to lead in Osogbo city and 42 apparently healthy subjects (mean age 30.1 ± 1.2) were used as controls. The plasma urea, creatinine, chloride and bicarbonate concentration were determined using modified Berthelot method, Jaffe's reaction, Schales and Schales method and back titration methods, respectively. The plasma sodium and potassium concentrations were determined using flame emission spectrophotometry while blood lead level was also determined using atomic absorption spectrophotometry. The result showed significant increases in mean plasma concentration of creatinine (84.9 ± 13.6-97.4 ± 28.7 μmol/L), sodium (131.9 ± 3.9-134.8 ± 3.7 mmol/L) and chloride (98.2 ± 4.0-100.4 ± 3.9 mmol/L) in test subjects when compared with controls (p < 0.05). Furthermore, significant increases (p < 0.01) were observed in mean plasma concentration of urea (4.7 ± 1.2-5.7 ± 1.3 mmol/L) and blood lead levels (18.5 ± 3.5-69.7 ± 13.2 mg/L) in test subjects in comparison with controls. In contrast, there were no significant differences observed when mean plasma potassium and bicarbonate levels in test subjects were compared with controls (p > 0.05). These results indicate that occupational exposure to lead may compromise renal function.
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Affiliation(s)
- A J Onuegbu
- Department of Biomedical Sciences, College of Health Sciences, Osogbo, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
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13
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Abdallah GM, El-Sayed ESM, Abo-Salem OM. Effect of lead toxicity on coenzyme Q levels in rat tissues. Food Chem Toxicol 2010; 48:1753-6. [PMID: 20385196 DOI: 10.1016/j.fct.2010.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 03/21/2010] [Accepted: 04/06/2010] [Indexed: 10/19/2022]
Abstract
Lead is a persistent and common environmental contaminant, which chiefly plays a significant role in modern industry. Coenzyme Q acts as electron and proton carrier in mitochondria and functions as an antioxidant in its reduced form (ubiquinol). To investigate the hazardous effects of lead on the coenzyme Q level, rats were injected i.p. with lead acetate (5 mg/kg b.wt. daily for 6 weeks). Our results showed that the levels of both oxidized (ubiquinone) and reduced (ubiquinol) forms of coenzyme Q(9) and Q(10) in serum, brain, liver and kidney of lead-treated rats are quite different depending on the organ tissue type.
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Affiliation(s)
- Gamil M Abdallah
- Biochemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr-City, Cairo, Egypt
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14
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Estimation of Benchmark Dose for Bone Damage and Renal Dysfunction in a Chinese Male Population Occupationally Exposed to Lead. ACTA ACUST UNITED AC 2008; 52:527-33. [DOI: 10.1093/annhyg/men031] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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15
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Sattar S, Carroll MJ, Sargeant AA, Swift JA. Structure of a lead urate complex and its effect on the nucleation of monosodium urate monohydrate. CrystEngComm 2008. [DOI: 10.1039/b715586g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Batuman V. Lead chelation therapy retards the decline of renal function in patients with chronic kidney disease. NATURE CLINICAL PRACTICE. NEPHROLOGY 2007; 3:646-7. [PMID: 17895871 DOI: 10.1038/ncpneph0617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 08/15/2007] [Indexed: 05/17/2023]
Affiliation(s)
- Vecihi Batuman
- Tulane University School of Medicine and Veterans Affairs Medical Center in New Orleans, LA, USA.
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Parathyroid Hormone Status Does Not Influence Blood and Bone Lead Levels in Dialysis Patients. Am J Med Sci 2007; 334:415-20. [DOI: 10.1097/maj.0b013e318068b237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Vaziri ND, Khan M. Interplay of reactive oxygen species and nitric oxide in the pathogenesis of experimental lead-induced hypertension. Clin Exp Pharmacol Physiol 2007; 34:920-5. [PMID: 17645641 DOI: 10.1111/j.1440-1681.2007.04644.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
1. Lead is a common environmental and industrial toxin that can cause a variety of acute and chronic illnesses. For example, chronic exposure to low levels of lead has been shown to raise arterial pressure and promote renal and cardiovascular complications. 2. Several mechanisms have been identified by which chronic lead exposure can cause hypertension and cardiovascular disease. In recent years, increasing evidence has emerged pointing to the role of oxidative stress as a major mediator of lead-induced hypertension. 3. The present article provides an overview of the published studies on this subject.
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Affiliation(s)
- N D Vaziri
- Division of Nephrology and Hypertension, University of California, Irvine, California, USA.
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19
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Muntner P, Menke A, Batuman V, Rabito FA, He J, Todd AC. Association of tibia lead and blood lead with end-stage renal disease: a pilot study of African-Americans. ENVIRONMENTAL RESEARCH 2007; 104:396-401. [PMID: 17511982 DOI: 10.1016/j.envres.2007.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 03/19/2007] [Accepted: 04/04/2007] [Indexed: 05/07/2023]
Abstract
The association between body lead burden and kidney disease remains controversial. Fifty-five African-American end-stage renal disease (ESRD) cases and 53 age- and sex-matched African-American controls without known renal disease were recruited from Tulane University-affiliated dialysis clinics and out-patient clinics, respectively. Blood lead was measured via atomic absorption spectrophotometry and tibia lead (a measure of body lead) was measured via (109)Cd-based K shell X-ray fluorescence. Median blood lead levels were significantly higher among ESRD cases (6 microg/dL) compared to their control counterparts (3 microg/dL; P<0.001). Although no participants had overt lead poisoning (blood lead > or = 25 microg/dL), seven cases but no controls had blood lead levels above 10 microg/dL (P=0.006). The median tibia lead level was 17 micrograms of lead per gram of bone mineral (microg/g) and 13 microg/g among ESRD cases and their control counterparts, respectively (P=0.134). Four ESRD cases (7%), but no controls, had a tibia lead level above 40 microg/g (P=0.115) while a similar proportion of cases and controls had tibia lead between 20 and 39 microg/g (33% and 32%, respectively; P=0.726). After adjustment for potential confounders, the odds ratios of ESRD associated with a tibia lead > or = 20 microg/g and each four-fold higher tibia lead (e.g., 5-20 microg/g) were 1.55 (95% CI: 0.55, 4.41) and 1.88 (95% CI: 0.53, 6.68), respectively. These findings support the need for prospective cohort studies of body lead burden and renal disease progression.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
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Abstract
PURPOSE Common sources of lead exposure, the primary clinical effects of lead toxicity, and current recommendations for managing lead toxicity, including chelation therapy, are reviewed. SUMMARY Common sources of lead exposure in children and adults include industrial and mining activities, paint, dust, soil, water, air, the workplace, food, trinkets, ethnic folk remedies, and cosmetics. The absorption and biological fate of lead are affected by a variety of factors, including an individual's nutritional status, health, and age. Children with a blood lead concentration of >10 microg/dL and adults with a blood lead concentration of > or = 45 mug/dL should undergo further evaluation. Symptoms and time to onset of symptoms postexposure may vary, and it can be difficult to identify the early, subtle neurologic effects of lead toxicity. The classic symptoms of lead toxicity generally correlate with blood lead concentrations of 25-50 microg/dL in children and 40-60 microg/dL in adults. Management of lead toxicity requires extensive risk assessment and caregiver education. Chelation is generally not indicated for adults with blood lead concentrations of < 45 microg/dL because of the potential risk of adverse drug events and concerns about remobilized lead, and chelation for children with blood lead concentrations of < 45 microg/dL remains controversial. Dimercaprol, edetate calcium disodium, and succimer are the three agents primarily used for chelation. CONCLUSION Lead toxicity remains a significant public health concern. Elimination of elevated blood lead levels in children can be accomplished by educating appropriate health care providers and caregivers, recognizing potential lead sources, and adopting aggressive prevention and case management measures.
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Menke A, Muntner P, Batuman V, Silbergeld EK, Guallar E. Blood Lead Below 0.48 μmol/L (10 μg/dL) and Mortality Among US Adults. Circulation 2006; 114:1388-94. [PMID: 16982939 DOI: 10.1161/circulationaha.106.628321] [Citation(s) in RCA: 309] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Blood lead levels above 0.48 μmol/L (10 μg/dL) in adults have been associated with increased risk of cardiovascular, cancer, and all-cause mortality. The objective of the present study was to determine the association between blood lead levels below 0.48 μmol/L and mortality in the general US population.
Methods and Results—
Blood lead levels were measured in a nationally representative sample of 13 946 adult participants of the Third National Health and Nutrition Examination Survey recruited in 1988 to 1994 and followed up for up to 12 years for all-cause and cause-specific mortality. The geometric mean blood lead level in study participants was 0.12 μmol/L (2.58 μg/dL). After multivariate adjustment, the hazard ratios (95% CI) for comparisons of participants in the highest tertile of blood lead (≥0.17 μmol/L [≥3.62 μg/dL]) with those in the lowest tertile (<0.09 μmol/L [<1.94 μg/dL]) were 1.25 (1.04 to 1.51;
P
trend
across tertiles=0.002) for all-cause mortality and 1.55 (1.08 to 2.24;
P
trend
across tertiles=0.003) for cardiovascular mortality. Blood lead level was significantly associated with both myocardial infarction and stroke mortality, and the association was evident at levels >0.10 μmol/L (≥2 μg/dL). There was no association between blood lead and cancer mortality in this range of exposure.
Conclusions—
The association between blood lead levels and increased all-cause and cardiovascular mortality was observed at substantially lower blood lead levels than previously reported. Despite the marked decrease in blood lead levels over the past 3 decades, environmental lead exposures remain a significant determinant of cardiovascular mortality in the general population, constituting a major public health problem.
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Affiliation(s)
- Andy Menke
- Department of Epidemiology, Tulane University SPHTM, 1430 Tulane Ave, New Orleans, LA 70112, USA
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23
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Lin JL, Lin-Tan DT, Yu CC, Li YJ, Huang YY, Li KL. Environmental exposure to lead and progressive diabetic nephropathy in patients with type II diabetes. Kidney Int 2006; 69:2049-56. [PMID: 16641918 DOI: 10.1038/sj.ki.5001505] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Studies indicate that environmental exposure to lead is associated with reduced renal function. Whether lead affects progressive diabetic nephropathy is unclear. Eighty-seven patients with type II diabetes and diabetic nephropathy (serum creatinine of 1.5-3.9 mg/dl) with normal body lead burden and no lead exposure history were observed over a 12-month period. Thirty subjects with high normal body lead burdens (80-600 microg) were randomly assigned to a chelation and control group. For 3 months, the 15 chelation-group patients underwent lead-chelation therapy with calcium disodium ethylenediaminetetraacetic acid weekly until body lead burden fell <60 microg, and the 15 control group subjects received a weekly placebo. During the following 12 months, renal function was regularly assessed at 3-month intervals. The primary outcome was an elevation of serum creatinine to 1.5 times baseline value during the observation period. A secondary outcome was temporal changes in renal function following chelation therapy. Twenty-six patients achieved the primary outcome. Basal blood lead levels and body lead burden were the most important risk factors in predicting progressive diabetic nephropathy. Following chelation, the rates of decline in glomerular filtration rates in the chelation group and the control group, respectively, were 5.0+/-5.7 ml and 11.8+/-7.0 ml/min/year/1.73 m(2) of body surface area (P=0.0084) during follow-up, although both groups had similar rates of progression of renal function during the 12-month observation period. We concluded that low-level environmental lead exposure accelerates progressive diabetic nephropathy and lead-chelation therapy can decrease its rate of progression.
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Affiliation(s)
- J-L Lin
- Division of Nephrology and Clinical Toxicology, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Taipei, Taiwan, ROC.
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Guallar E, Silbergeld EK, Navas-Acien A, Malhotra S, Astor BC, Sharrett AR, Schwartz BS. Confounding of the relation between homocysteine and peripheral arterial disease by lead, cadmium, and renal function. Am J Epidemiol 2006; 163:700-8. [PMID: 16484446 DOI: 10.1093/aje/kwj090] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Homocysteine levels are associated with peripheral arterial disease (PAD) in observational studies. Lead and cadmium are risk factors for PAD that affect thiol metabolism, and they may partly explain the association of homocysteine with PAD. To evaluate the roles of lead and cadmium exposure in confounding the association between homocysteine and PAD, the authors performed a cross-sectional study among 4,447 persons aged > or = 40 years who participated in the 1999-2002 National Health and Nutrition Examination Survey (NHANES). PAD was defined as an ankle-brachial blood pressure index less than 0.90 in at least one leg. After adjustment for sociodemographic variables, the odds ratio for PAD in the highest quintile of homocysteine compared with the lowest was 1.92 (p(trend) = 0.004). Adjusting for blood lead and cadmium levels reduced this odds ratio to 1.37 (p(trend) = 0.13), and further adjusting for estimated glomerular filtration rate and smoking reduced it to 0.89 (p(trend) = 0.87). Adjustment for other risk factors did not affect this association. In the general population, the association of homocysteine level with PAD can be completely explained by confounding due to smoking, increased blood lead and cadmium levels, and impaired renal function. The association of lead and cadmium with PAD risk deserves further investigation.
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Affiliation(s)
- Eliseo Guallar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Vigeh M, Yokoyama K, Ramezanzadeh F, Dahaghin M, Sakai T, Morita Y, Kitamura F, Sato H, Kobayashi Y. Lead and other trace metals in preeclampsia: a case-control study in Tehran, Iran. ENVIRONMENTAL RESEARCH 2006; 100:268-75. [PMID: 16029873 DOI: 10.1016/j.envres.2005.05.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2004] [Revised: 05/23/2005] [Accepted: 05/26/2005] [Indexed: 05/03/2023]
Abstract
To assess the effects of environmental exposures to trace metals on the incidence of preeclampsia, concentrations of lead (Pb), antimony (Sb), manganese (Mn), mercury, cadmium, cobalt and zinc in umbilical cord blood (UCB) and mother whole blood (MWB) were measured in 396 postpartum women without occupational exposure to metals in Tehran, Iran, using inductively coupled plasma mass spectrometry. Mother's ages ranged from 15 to 49 (mean 27) years. Preeclampsia was diagnosed in 31 subjects (7.8%). Levels of Pb, Sb and Mn in UCB were significantly higher in preeclampsia cases [mean+/-SD of 4.30+/-2.49 microg/dl, 4.16+/-2.73 and 46.87+/-15.03 microg/l, respectively] than in controls [3.52+/-2.09 microg/dl, 3.17+/-2.68 and 40.32+/-15.19 microg/l, respectively] (P<0.05). The logistic regression analysis revealed that one unit increase in the common logarithms of UCB concentration of Pb, Sb or Mn led to increase in the risk of preeclampsia several-fold; unit risks (95% CI) were 12.96 (1.57-107.03), 6.11 (1.11-33.53) and 34.2 (1.81-648.04) for Pb, Sb and Mn, respectively (P<0.05). These findings suggest that environmental exposure to Pb, Sb and Mn may increase the risk of preeclampsia in women without occupational exposure; levels of metals in UCB to be sensitive indicators of female reproductive toxicity as compared with those in mother MWB. Further studies are necessary to confirm these findings, especially on Sb and Mn.
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Affiliation(s)
- Mohsen Vigeh
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Hongo Bunkyo-ku, Tokyo, Japan
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Hernández-Serrato MI, Fortoul TI, Rojas-Martínez R, Mendoza-Alvarado LR, Canales-Treviño L, Bochichio-Riccardelli T, Avila-Costa MR, Olaiz-Fernández G. Lead blood concentrations and renal function evaluation: study in an exposed Mexican population. ENVIRONMENTAL RESEARCH 2006; 100:227-31. [PMID: 16442996 DOI: 10.1016/j.envres.2005.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Revised: 02/22/2005] [Accepted: 03/07/2005] [Indexed: 05/06/2023]
Abstract
The relation of blood Pb concentrations and renal dysfunction has been reported in association with interstitial fibrosis, tubular atrophy, and decreased glomerular filtration. In this report information about blood Pb concentrations and renal function tests in a population from Oaxaca, Mexico is analyzed. The main changes found were that males had higher blood Pb concentrations than females (P<0.0012); the leading variables associated with this were occupation (glazed pottery workers, P=0.0001) and the use of glazed pottery for preparing meals (P=0.0000). Variables that better explain uric acid variability were blood Pb concentrations, sex, weight, and height (r2=0.23). Hyperuricemia was associated with blood Pb concentrations above 40 microg/dL (OR=1.74, 95% CI, 1.12-2.61). SCr was associated with sex, age, and blood Pb, with coefficient r2=0.12. Our findings might be related to inadequate control of oven emissions, a situation that will require further analysis and the implementation of preventive measurements for the nonoccupational exposed population.
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Weaver VM, Jaar BG, Schwartz BS, Todd AC, Ahn KD, Lee SS, Wen J, Parsons PJ, Lee BK. Associations among lead dose biomarkers, uric acid, and renal function in Korean lead workers. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:36-42. [PMID: 15626645 PMCID: PMC1253707 DOI: 10.1289/ehp.7317] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2004] [Accepted: 09/30/2004] [Indexed: 05/21/2023]
Abstract
Recent research suggests that both uric acid and lead may be nephrotoxic at lower levels than previously recognized. We analyzed data from 803 current and former lead workers to determine whether lead biomarkers were associated with uric acid and whether previously reported associations between lead dose and renal outcomes were altered after adjustment for uric acid. Outcomes included uric acid, blood urea nitrogen, serum creatinine, measured and calculated creatinine clearances, and urinary N-acetyl-ss-d-glucosaminidase (NAG) and retinol-binding protein. Mean (+/- SD) uric acid, tibia lead, and blood lead levels were 4.8 +/- 1.2 mg/dL, 37.2 +/- 40.4 microg/g bone mineral, and 32.0 +/- 15.0 microg/dL, respectively. None of the lead measures (tibia, blood, and dimercaptosuccinic-acid-chelatable lead) was associated with uric acid, after adjustment for age, sex, body mass index, and alcohol use. However, when we examined effect modification by age on these relations, both blood and tibia lead were significantly associated (ss = 0.0111, p < 0.01 and ss = 0.0036, p = 0.04, respectively) in participants in the oldest age tertile. These associations decreased after adjustment for blood pressure and renal function, although blood lead remained significantly associated with uric acid (ss = 0.0156, p = 0.01) when the population was restricted to the oldest tertile of workers with serum creatinine greater than the median (0.86 mg/dL). Next, in models of renal function in all workers, uric acid was significantly (p < 0.05) associated with all renal outcomes except NAG. Finally, in the oldest tertile of workers, associations between lead dose and NAG were unchanged, but fewer associations between the lead biomarkers and the clinical renal outcomes remained significant (p less than or equal to 0.05) after adjustment for uric acid. In conclusion, our data suggest that older workers comprise a susceptible population for increased uric acid due to lead. Uric acid may be one, but not the only, mechanism for lead-related nephrotoxicity.
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Affiliation(s)
- Virginia M Weaver
- Division of Occupational and Environmental Health, Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Abstract
Chronic, low-level lead exposure causes hypertension in both animals and humans. The pathogenesis of lead-induced hypertension is multifactorial, including such diverse mechanisms as: inactivation of endogenous nitric oxide and downregulation of soluble guanylate cyclase by reactive oxygen species (ROS), leading to a functional deficiency in nitric oxide; heightened sympathetic activity and plasma norepinephrine together with depressed vascular and elevated renal beta-adrenergic receptor density; elevated plasma angiotensin-converting enzyme (ACE) activity, plasma renin activity (PRA), angiotensin II (Ang-II), and aldosterone levels; increased kininase I and kininase II activities; lead-induced inhibition of vascular smooth muscle Na(+)-K+ ATPase, leading to a rise in cellular Na+ and, hence, Ca2+; and a possible rise in endothelin and thromboxane generation. In this article, we present an overview of the epidemiology and proposed underlying mechanisms of lead-induced hypertension.
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Affiliation(s)
- Nosratola D Vaziri
- Division of Nephrology and Hypertension, University of California, Irvine, UCI Medical Center, 101 The City Drive, Building 53, Room 125, Route 81, Orange, CA 92868, USA.
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Brewster UC, Perazella MA. A Review of Chronic Lead Intoxication: An Unrecognized Cause of Chronic Kidney Disease. Am J Med Sci 2004; 327:341-7. [PMID: 15201648 DOI: 10.1097/00000441-200406000-00008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic lead nephropathy occurs as a result of years of lead exposure. This disease has been prevalent throughout human history. It is important that primary care providers and internists recognize this disorder because it can contribute to progressive loss of kidney function. Diagnosis is made by a thorough history in combination with physical examination. A history of lead intoxication often requires knowledge of the various sources of lead exposure. Laboratory tests, many previously known and some newly described, are available to further support this diagnosis. Therapy to reduce lead burden may be useful when employed early in the disease; new data sheds more light on which patients should be treated and when such patients should undergo chelation therapy. In particular, treatment with calcium EDTA chelation may benefit certain patients with chronic kidney disease by slowing the progression to end-stage renal disease.
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Affiliation(s)
- Ursula C Brewster
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA
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Weaver VM, Lee BK, Ahn KD, Lee GS, Todd AC, Stewart WF, Wen J, Simon DJ, Parsons PJ, Schwartz BS. Associations of lead biomarkers with renal function in Korean lead workers. Occup Environ Med 2003; 60:551-62. [PMID: 12883015 PMCID: PMC1740600 DOI: 10.1136/oem.60.8.551] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS To compare associations of lead biomarkers with renal function in current and former lead workers. METHODS Cross sectional analysis of first year results from a longitudinal study of 803 lead workers and 135 controls in South Korea. Clinical renal function was assessed by blood urea nitrogen (BUN), serum creatinine, and measured and calculated creatinine clearance. Urinary N-acetyl-beta-D-glucosaminidase (NAG) and retinol-binding protein were also measured. RESULTS Mean (SD) tibia lead, blood lead, and DMSA chelatable lead levels in lead workers were 37.2 (40.4) micro g/g bone mineral, 32.0 (15.0) micro g/dl, and 767.8 (862.1) micro g/g creatinine, respectively. Higher lead measures were associated with worse renal function in 16/42 models. When influential outliers were removed, higher lead measures remained associated with worse renal function in nine models. An additional five associations were in the opposite direction. Effect modification by age was observed. In 3/16 models, associations between higher lead measures and worse clinical renal function in participants in the oldest age tertile were significantly different from associations in those in the youngest age tertile which were in the opposite direction. Mean urinary cadmium (CdU) was 1.1 micro g/g creatinine (n = 191). Higher CdU levels were associated with higher NAG. CONCLUSIONS These data suggest that lead has an adverse effect on renal function in the moderate dose range, particularly in older workers. Associations between higher lead measures and lower BUN and serum creatinine and higher creatinine clearances may represent lead induced hyperfiltration. Environmental cadmium may also have an adverse renal impact, at least on NAG.
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Affiliation(s)
- V M Weaver
- Division of Occupational and Environmental Health, Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Muntner P, He J, Vupputuri S, Coresh J, Batuman V. Blood lead and chronic kidney disease in the general United States population: results from NHANES III. Kidney Int 2003; 63:1044-50. [PMID: 12631086 DOI: 10.1046/j.1523-1755.2003.00812.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND High lead exposure is associated with hypertension and renal dysfunction but the effect of low-level environmental exposure is not as well studied. METHODS We examined the association between blood lead and renal function among a representative sample of the civilian noninstitutionalized United States population with and without hypertension, age 20 years old or older, participating in the Third National Health and Nutrition Examination Survey (NHANES III) (N=15211). Elevated serum creatinine was defined as >or=99th percentile of each race-sex specific distribution for healthy young adults and chronic kidney disease (CKD) as a glomerular filtration rate (GFR) <60 mL/min estimated using the Modification of Diet in Renal Disease (MDRD) formula. RESULTS Among persons with and without hypertension, mean blood lead was 4.21 and 3.30 ug/dL, respectively, the prevalence of elevated serum creatinine was 11.5% and 1.8%, respectively, and CKD was 10.0% and 1.1%, respectively. Among persons with hypertension, a graded association was present between higher quartile of blood lead and a higher odds ratio of both an elevated serum creatinine and CKD. Comparing the highest to lowest quartile of blood lead, the multivariate adjusted odds ratio (95% CI) of an elevated serum creatinine and CKD were 2.41 (1.46, 3.97) and 2.60 (1.52, 4.45), respectively. The analogous adjusted odds ratios (95% CI) among normotensives were 1.09 (0.53, 2.22) and 1.09 (0.41, 2.89), respectively. Associations were consistent when modeling lead as a continuous variable and in all subgroups except smokers. CONCLUSION In the United States population with hypertension, exposure to lead, even at low levels, is associated with CKD. Reduction of lead exposure may reduce the burden of CKD in the community.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112, USA.
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Vupputuri S, He J, Muntner P, Bazzano LA, Whelton PK, Batuman V. Blood lead level is associated with elevated blood pressure in blacks. Hypertension 2003; 41:463-8. [PMID: 12623944 DOI: 10.1161/01.hyp.0000055015.39788.29] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic lead exposure has been associated with elevated blood pressure in epidemiological studies. It is not known whether the previously observed relation between blood lead and hypertension persists after significant reductions have been made in environmental lead contamination. We examined the relation between blood lead levels and blood pressure in a representative sample of 14 952 whites and blacks aged 18 years or older who participated in the Third National Health and Nutrition Examination Survey. Blood lead was measured by atomic absorption spectrophotometry and blood pressure by standard sphygmomanometry. Mean blood lead levels were significantly higher for black men and women (5.4 and 3.4 microg/dL, respectively) compared with white men and women (4.4 and 3.0 microg/dL, respectively). After multivariate adjustment for important covariables, each standard deviation higher blood lead (3.3 microg/dL) was associated with a 0.82 (95% confidence interval [CI], 0.19 to 1.44) mm Hg and a 1.55 (95% CI, 0.47 to 2.64) mm Hg higher systolic blood pressure among black men and women, respectively. In contrast, blood lead level was not associated with blood pressure among white men or women. The multivariate-adjusted odds ratio (95% CI) of hypertension associated with a 1-SD higher level of blood lead was 1.08 (95% CI, 0.99 to 1.19) for black men and 1.39 (95% CI, 1.21 to 1.61) for black women. These findings suggest that increased levels of blood lead remain an important environmental risk factor for elevated blood pressure in blacks.
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Affiliation(s)
- Suma Vupputuri
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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Lin JL, Lin-Tan DT, Hsu KH, Yu CC. Environmental lead exposure and progression of chronic renal diseases in patients without diabetes. N Engl J Med 2003; 348:277-86. [PMID: 12540640 DOI: 10.1056/nejmoa021672] [Citation(s) in RCA: 211] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous research suggests that environmental lead exposure correlates with age-related decreases in renal function. METHODS Two hundred two patients with chronic renal insufficiency (indicated by a serum creatinine level between 1.5 mg per deciliter and 3.9 mg per deciliter) who had a normal total-body lead burden and no history of exposure to lead were observed for 24 months. After the observation period, 64 subjects with an elevated body lead burden were randomly assigned to the chelation control groups. For three months, the patients in the chelation group received lead-chelation therapy with calcium disodium EDTA, and the control group received placebo. During the ensuing 24 months, repeated chelation therapy was administered weekly to 32 patients with high-normal body lead burdens (at least 80 microg but less than 600 microg) unless on repeated testing the body lead burden fell below 60 microg; the other 32 patients served as controls and received weekly placebo infusions for 5 weeks every 6 months. The primary end point was an increase in the serum creatinine level to 1.5 times the base-line value during the observation period. A secondary end point was the change in renal function during the intervention period. RESULTS The primary end point occurred in 24 patients during the observation period; the serum creatinine levels and body lead burden at base line were the most important risk factors. The glomerular filtration rate improved significantly by the end of the 27-month intervention period in patients receiving chelation therapy: the mean (+/-SD) change in the glomerular filtration rate in the patients in the chelation group was 2.1+/-5.7 ml per minute per 1.73 m2 of body-surface area, as compared with -6.0+/-5.8 ml per minute per 1.73 m2 of body-surface area in the controls (P<0.001). The rate of decline in the glomerular filtration rate in the chelation group was also lower than that in the controls during the 24-month period of repeated chelation therapy or placebo. CONCLUSIONS Low-level environmental lead exposure may accelerate progressive renal insufficiency in patients without diabetes who have chronic renal disease. Repeated chelation therapy may improve renal function and slow the progression of renal insufficiency.
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Affiliation(s)
- Ja-Liang Lin
- Division of Nephrology, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Medical College of Chang Gung University, Taipei, Taiwan.
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Mattioli S, Truffelli D, Baldasseroni A, Risi A, Marchesini B, Giacomini C, Bacchini P, Violante FS, Buiatti E. Occupational risk factors for renal cell cancer: a case--control study in northern Italy. J Occup Environ Med 2002; 44:1028-36. [PMID: 12448354 DOI: 10.1097/00043764-200211000-00009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Relatively little is known about occupational and other risk factors for renal-cell carcinoma (RCC). Associations between RCC and occupations, exposures and other factors were investigated in a hospital-based case-control study in Bologna (central-northern Italy). Between 1986 and 1994, 324 histologically confirmed RCC cases were diagnosed at Policlinico S. Orsola-Malpighi in patients from the Province of Bologna. Corresponding control subjects admitted to the same hospital with any diagnosis except RCC were matched for sex, age, and residency. We studied the 249 cases and 238 controls for whom detailed information on occupational history, diet, smoking habits, alcohol and drug intake was obtained. At conditional logistic regression, among males (167 matched pairs), significant matched odds ratios (OR) were found, after adjusting for cigarette smoking and alcohol intake, for high body-mass index BMI (third quartile: OR, 4.91; confidence interval [95% CI], 1.56-15.5; last quartile: OR, 4.42; 95% CI, 1.48-13.18), railway workers (OR, 10.14; 95% CI, 1.46-70.17) and asbestos exposure (OR, 7.11; 95% CI, 1.46-34.51); nearly significant OR were found for managers (OR, 3.59; 95% CI, 0.82-15.59) and metal workers (OR, 2.21; 95% CI, 0.99-5.37). Among females (52 pairs), significant OR were found for BMI > 25.4 (OR, 8.46; 95% CI, 1.02-68.0). Railway workers (on or near to trains) may have increased risk of developing RCC, possibly due to asbestos exposure. Studies are required on possible risks encountered by railway (and metal) workers and by managers.
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Affiliation(s)
- Stefano Mattioli
- Unità Operativa di Medicina del Lavoro, Policlinico Sant'Orsola-Malpighi, Via Pelagio Palagi 9, I-40138 Bologna, Italy.
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Abstract
PURPOSE Chronic occupational exposure to lead is related to low urate excretion and a high incidence of gout in lead workers. However, whether chronic low-level environmental lead exposure influences urate excretion in the general population remains unknown. SUBJECTS AND METHODS We studied 111 healthy subjects with normal renal function (serum creatinine level < or =1.4 mg/dL) and no previous lead exposure or systemic diseases. All subjects had their blood lead levels measured, received ethylenediaminetetraacetic acid mobilization tests to assess their body lead burdens, and were investigated for renal function and urate excretion to assess the relation between lead and urate excretion. We studied urate excretion before and after lead chelation therapy in 24 subjects with high-normal body lead burden (>78 mg and <600 mg). RESULTS Healthy subjects with gout (n = 27) manifested a higher body lead burden (84 +/- 42 mg vs. 45 +/- 30 mg, P <0.0001) and lower urate clearance (3.7 +/- 1.2 mL/min/1.73 m(2) vs. 6.0 +/- 2.8 mL/min/1.73 m(2), P <0.0001) than did those without gout (n = 84). Blood lead levels and body lead burden of all subjects were within the safe range. In analyses that adjusted for age, sex, body mass index, protein intake, and creatinine clearance, blood lead level was significantly related to serum urate level (beta coefficient [+/- SE] = 0.23 +/- 0.11, P = 0.03), and body lead burdens were related to all indices of urate excretion (serum urate: beta coefficient = 0.023 +/- 0.005, P <0.0001; daily urate excretion: beta coefficient = -1.55 +/- 0.40, P = 0.0002; urate clearance: beta coefficient = -0.030 +/- 0.006, P <0.0001; fractional urate excretion: beta coefficient= -0.034 +/- 0.006, P <0.0001). Following lead chelation therapy, urate clearance increased after body lead burden was reduced (3.4 +/- 1.2 mL/min/1.73 m(2) vs. 4.9 +/- 1.4 mL/min/1.73 m(2), P <0.005). CONCLUSION Chronic low-level environmental lead exposure may inhibit urate excretion in the general population, and lead chelation therapy reduces this inhibition. These findings support efforts to reduce sources of environmental lead exposure and suggest alternative approaches to hyperuricemia and gout in the general population.
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Affiliation(s)
- Ja-Liang Lin
- Poison Center, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Chang Gung Medical College and University, 199 Tung Hwa North Road, Taipei, Taiwan, ROC.
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Abstract
Gout secondary to lead-induced nephropathy is a long-term complication of occupational lead exposure. We report a case of this now-rare condition. The patient was a 63-year-old man who had been a miner from 1950 to 1970. Thirty years after cessation of his exposure to lead, he experienced onset of inflammatory symmetric polyarthritis with joint deformities. Hyperuricemia, moderately severe renal failure, and tubular acidosis were found, indicating gouty polyarthritis. Blood lead levels were high, establishing that the cause was lead poisoning. EDTA chelation therapy was effective. Lead poisoning is frequently under-recognized because the clinical manifestations are often minimal and the diagnosis difficult to establish. We suggest that lead bound to bone may result in continued exposure to lead after cessation of industrial or environmental exposure. Chelating agents are valuable for the diagnosis and can ensure a full recovery.
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Schwartz BS, Lee BK, Lee GS, Stewart WF, Lee SS, Hwang KY, Ahn KD, Kim YB, Bolla KI, Simon D, Parsons PJ, Todd AC. Associations of blood lead, dimercaptosuccinic acid-chelatable lead, and tibia lead with neurobehavioral test scores in South Korean lead workers. Am J Epidemiol 2001; 153:453-64. [PMID: 11226977 DOI: 10.1093/aje/153.5.453] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The authors performed a cross-sectional study to evaluate associations between blood lead, tibia lead, and dimercaptosuccinic acid (DMSA)-chelatable lead and measures of neurobehavioral and peripheral nervous system function among 803 lead-exposed workers and 135 unexposed controls in South Korea. The workers and controls were enrolled in the study between October 1997 and August 1999. Central nervous system function was assessed with a modified version of the World Health Organization Neurobehavioral Core Test Battery. Peripheral nervous system function was assessed by measuring pinch and grip strength and peripheral vibration thresholds. After adjustment for covariates, the signs of the beta coefficients for blood lead were negative for 16 of the 19 tests and blood lead was a significant predictor of worse performance on eight tests. On average, for the eight tests that were significantly associated with blood lead levels, an increase in blood lead of 5 microg/dl was equivalent to an increase of 1.05 years in age. In contrast, after adjustment for covariates, tibia lead level was not associated with neurobehavioral test scores. Associations with DMSA-chelatable lead were similar to those for blood lead. In these currently exposed workers, blood lead was a better predictor of neurobehavioral performance than was tibia or DMSA-chelatable lead, mainly in the domains of executive abilities, manual dexterity, and peripheral motor strength.
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Affiliation(s)
- B S Schwartz
- Division of Occupational and Environmental Health, Johns Hopkins School of Hygiene and Public Health, 615 North Wolfe St., Room 7041, Baltimore, MD 21205, USA.
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Abstract
In this work we have attempted to characterize the programmed cell death (apoptosis) in alveolar macrophages exposed to various concentrations of lead nitrate. It was found that after 3 h of exposure a significant increase in superoxide anion production was observed, i.e. the number of trypan blue - exculding cells, was unchanged (< or = 95%) with any dose of lead employed. Agarose gel electrophoresis and diphenylamin reaction analysis revealed the occurrence of internucleosomal DNA fragmentation evaluated using cytological analysis by fluorescence dyes, suggesting that lead nitrate at low concentrations and short periods of exposure leads macrophages into apoptosis. However, time course studies showed that beyond 3 h, toxicity occurs, which could be attenuated by phosphodiesterase inhibitors, such as caffeine, suggesting a possible mechanism involving cAMP.
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Affiliation(s)
- A Shabani
- Institute of Biochemistry and Biophysics, University of Tehran, P.O. Box 13145-1384, Tehran, Iran
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Barrientos Guzmán A, Sánchez Fructuoso A. Hipertensión y plomo. HIPERTENSION Y RIESGO VASCULAR 2000. [DOI: 10.1016/s1889-1837(00)71071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Luke RG. Hypertensive nephrosclerosis: pathogenesis and prevalence. Essential hypertension is an important cause of end-stage renal disease. Nephrol Dial Transplant 1999; 14:2271-8. [PMID: 10528641 DOI: 10.1093/ndt/14.10.2271] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- R G Luke
- Department of Internal Medicine, University of Cincinnati, College of Medicine, Ohio 45267-0557, USA
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Affiliation(s)
- A Rastegar
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Lauwerys RR, Bernard A, Roels H, Buchet JP. Health risk assessment of long-term exposure to non-genotoxic chemicals: application of biological indices. Toxicol Lett 1995; 77:39-44. [PMID: 7618167 DOI: 10.1016/0378-4274(95)03269-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
For chemical pollutants, health risk assessment of long-term exposure is usually best realized through an epidemiologic approach which attempts to link cumulative levels of exposure to the potential for occurrence of early adverse effects. For some chemicals, however, the frequency of peak exposures may be more relevant for assessing the health risk than the integrated dose. In very few circumstances, biological exposure indices directly reflect the cumulative dose (e.g. PCB in blood). More frequently they are indicators of short-term interval dose but provided they have been measured with a sufficient frequency, their integration over the duration of exposure may represent a valid surrogate of the cumulative dose. This has been clearly demonstrated for lead or cadmium in blood. The selection of the appropriate biological effect markers for the study of the dose-effect/dose-response relationships is frequently a controversial issue when information on the mechanism of action of the pollutant is insufficient. In this case, the study of the health significance of the observed biological changes may be required for assessing a meaningful no-adverse-effect level. For example, in adult male workers moderate exposure to lead may affect the synthesis of vasodilatory prostaglandins in the kidney but presently there is no indication that this effect should be taken into account to define the acceptable occupational exposure level to lead because it is not associated with an impairment of the hemodynamic response of the kidney to an acute protein load. On the contrary, a low-molecular-weight proteinuria induced by cadmium may be predictive of an increased age-related decline of the glomerular filtration rate. Although the use of early biological effect markers for the study of the dose-effect or dose-response relationships in humans is probably less affected by selection biases than morbidity data, the possibility of such an interference cannot be excluded. For example, in the general population, the tubulotoxic effects of cadmium may occur at a lower body burden of the metal than in adult male workers. Whatever the adverse biological effect considered, the application of an uncertainty factor remains justified when extrapolating a no-effect level from adult male workers to the general population.
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Affiliation(s)
- R R Lauwerys
- Industrial Toxicology and Occupational Medicine Unit, Faculty of Medicine, Catholic University of Louvain, Brussels, Belgium
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Abstract
Nephrosclerosis is literally defined as hardening of the kidneys (Greek derivation: nephros, kidney; sklerosis, hardening). It is the result of scarring or replacement of the normal renal parenchyma by dense collagenous tissue. In practice, nephrosclerosis refers to diseases with predominant pathologic changes occurring in the preglomerular microvasculature and secondarily involving the glomeruli and interstitium. The relationship between mild to moderate hypertension and either nephrosclerosis or end-stage renal disease (ESRD) remains circumstantial, although these syndromes have long been associated in the medical literature. Nephrologists credit hypertension as the etiology of nephrosclerosis in 25% of patients initiating Medicare-supported renal replacement therapy, even though other processes may cause similar renal pathologic findings. Strikingly, serum creatinine values infrequently increase in patients with long-standing mild to moderate hypertension. Patients classified as having hypertensive ESRD typically present with advanced disease, making the processes that initiated the renal disease difficult to detect. Nephrologists are twice as likely to label an African-American patient as having hypertensive nephrosclerosis, compared with a white patient, when presented with identical clinical histories. This review proposes that many patients classified as having hypertensive nephrosclerosis actually have intrinsic renal parenchymal diseases, renal artery stenosis, unrecognized episodes of accelerated hypertension, or a primary renal microvascular disease. The familial clustering of ESRD attributed to hypertension in African-Americans and the identification of genes associated with renal injury in animals support the concept that inherited factors may predispose to renal failure. African-American families often have members with ESRD from disparate etiologies, including hypertensive ESRD. This suggests that common mechanisms, be they inherited or environmental, underlie the development of progressive renal failure in diverse forms of nephropathy. Identification of the mechanisms producing susceptibility to progressive renal disease would support the concept that mild to moderate elevations in blood pressure per se are uncommon causes of nephrosclerosis.
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Affiliation(s)
- B I Freedman
- Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1053
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