Lead nephropathy and lead-related nephrotoxicity
- Virginia M Weaver, MD, MPH
Virginia M Weaver, MD, MPH
- Associate Professor of Environmental Health Sciences and Medicine
- Associate Faculty Member, Welch Center for Prevention, Epidemiology and Clinical Research
- Johns Hopkins Medical Institutions
- Bernard G Jaar, MD, MPH, FASN
Bernard G Jaar, MD, MPH, FASN
- Assistant Professor of Medicine and Epidemiology
- Associate Faculty, Welch Center for Prevention, Epidemiology and Clinical Research
- Johns Hopkins Medical Institutions
- Nephrology Center of Maryland
Chronic lead exposure can affect a variety of organ systems, including the kidney, where it can produce lead nephropathy, a chronic interstitial nephritis. The high level of lead exposure required to cause lead nephropathy is now increasingly rare, particularly in developed countries, due to occupational controls and removal of lead from paint, gasoline, and other environmental sources (figure 1).
However, prolonged lead exposure at the lower levels encountered in developed countries may still contribute to renal toxicity, an association that has been referred to as lead-related nephrotoxicity . This is most likely to occur in patients who have chronic kidney disease (CKD) or are at risk because of diabetes mellitus or hypertension.
The impact of chronic lead exposure on the kidney will be reviewed here. Other clinical manifestations of lead poisoning, as well as the evaluation and management of lead poisoning in adults and children, are discussed separately. (See "Adult occupational lead poisoning" and "Childhood lead poisoning: Clinical manifestations and diagnosis" and "Childhood lead poisoning: Management".)
SOURCES OF LEAD EXPOSURE
There are a number of current sources of lead exposure, which are primarily related to occupational exposures in adults and to ingestion or inhalation of environmental lead in adults and children (table 1). In addition, since lead accumulates in bone, the body lead burden from past exposures also contributes to current exposure.
Exposure sources are discussed in detail elsewhere. (See "Adult occupational lead poisoning", section on 'Sources of exposure' and "Childhood lead poisoning: Exposure and prevention", section on 'Exposure'.)
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- SOURCES OF LEAD EXPOSURE
- MEASUREMENT OF LEAD DOSE
- LEAD NEPHROPATHY
- Clinical manifestations
- LEAD-RELATED NEPHROTOXICITY
- Studies supporting the association of lead with nephrotoxicity
- - Risk in general population
- - Risk in susceptible patient populations
- - Risk in children
- - Chelation studies
- - Lead-induced hyperfiltration
- Evaluation and therapy
- - Chelation therapy and chronic kidney disease progression
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- SUMMARY AND RECOMMENDATIONS