, larion H. (1974). British Journal of Industrial Medicine, 31, 113-127. Renal ultrastructure, renal function, and parameters of lead toxicity in workers with different periods of lead exposure. Renal biopsies were obtained from five men with heavy occupational exposure to lead and compared with studies of their renal function and parameters of lead toxicity. Two men had lead exposure of less than one year while three men had been exposed for from four to more than 30 years. In addition, renal function studies were performed in two men from whom renal biopsies could not be obtained. Their lead exposures were five and 12 years, respectively. Significantly lower plasma levels, when compared with non-exposed controls, were found for proline, valine, tyrosine, and phenylalanine although no excessive aminoaciduria was found. Renal function tests were normal in all except for a reduced glomerular filtration rate (GFR) in one worker. Plasma ALA was measured by a new and highly specific method and ALA clearance was found to follow GFR closely. Those workers with prolonged lead exposure showed a lower urinary lead excretion. Typical lead-induced intranuclear inclusion bodies were found only in those with short exposure. The ultrastructural changes were localized to the proximal tubules, while the glomeruli were only nonspecifically affected. Mitochondrial changes were found in all men. Reasons for the decrease in inclusion body formation in chronic lead nephropathy are uncertain but may be due to an increased rate of renal cell turnover or a consequence of chelation therapy.

between lead in blood, lead in urine and ALA in urine during lead work. One hundred and seventy-seven workers from a storage battery factory were examined for lead in blood and lead and 8-aminolevulinic acid (ALA) in urine. The workers were selected at random from those who had been employed for more than one month;most had beenemployed forseveral yearsat the same job. Thirty-sixworkers werefromdepartmentswithno leadexposure. In three departments with high exposure a rotating system with three weeks' exposure and three weeks' non-exposed work was applied. As the aim of the study was to establish the relationships between the three parameters during constant exposure, the values from these men were treated separately.The relationship between lead in blood and urinary ALA was best described by a curvilinear function: ALA = 100.0157 Pbb-lO0985, while the regression lines for ALA on lead in urine, and lead in urine on lead in blood were straight.Workers from the departments with the rotating system showed lower values for urinary lead and ALA, compared with non-rotating workers with the same level of lead in blood. All these workers were examined daring their second or third week of lead work, i.e., with an accumulating lead body burden. This system may be beneficial, especially in departments where prophylactic measures are difficult to install, or for notoriously careless workers.Those who showed comparatively high ALA and urinary lead values in relation to their blood lead level were found to be workers with repeated incidents of metabolic lead influence, in whom the ALA values had seldom been normal.The mean values from different factory departments were of the same order as would be expected from previous studies in storage battery plants.The results are discussed in relation to present concepts of lead absorption and poisoning.Determinations of lead in blood, lead in urine, and 8-aminolevulinic acid (ALA) in urine are considered to be three of the most reliable tests used in the control of lead-exposed workers. Several investigations concerning the relationship between these parameters and their merits as measures of lead absorption and lead poisoning have been published. Sweden Discrepancies between the results can often be explained by differences with regard to the materials and the plan of investigation, and the results are often given in such a way that it is difficult to make direct comparisons. These laboratory analyses are also all somewhat elaborate and some of the published results may therefore be questioned. However, in well-planned investigations performed under standardized conditions a definite correlation between the three parameters has always been shown 28 Interrelationships between lead in blood, lead in urine, and ALA in urine during lead work 29 (Haeger-Aronsen, 1960; Cramer and Selander, 1965; Selander, Cramdr, and Hallberg, 1966;de Bruin and Hoolboom, 1967;Stopps, 1968; Williams, King, and Walford, 1969 Table), in which work is largely independent of one another. In one department...

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The urinary output of a-aminolaevulic acid (ALA), coproporphyrins, and lead in 15 leadintoxicated workers was determined and correlated with the degree of intoxication. Raised levels of ALA in the urine show the best agreement with clinical evidence of intoxication.In addition these values were correlated with the amount of lead excreted after treatment with a total dosage of 9 g. penicillamine. Weak correlations were found between therapeutically excreted lead and initial values for lead and coproporphyrin in urine. In contrast the initial values for ALA correlate very closely (P < 0 001). It is concluded that determinations of the output of ALA are to be preferred in the evaluation of lead intoxication and that they point directly to the amount of metabolically active lead in the organism.

Radiological findings by coronary angiography in 224 patients, 173 males and 51 females, were graded according to the rate of filling of coronary arteries and to the presence or absence of obstruction of vessel lumen. The material was then grouped according to age, diastolic blood pressure, serum total cholesterol, serum glycerides, and smoking habits. Age and diastolic blood pressure were not found to have any influence on frequency of coronary artery changes, presumably because of selection of patients. In the males, elevated total serum cholesterol had only a minor influence on the frequency of coronary artery changes, while elevated glycerides were found in high frequency in patients with obstructed coronary arteries, especially in those with severe obstruction. If patients put on lipid-reducing therapy or diet were added to those with serum cholesterol higher than 280 mg/100 ml, a slight overrepresentation of coronary changes was found when compared with patients with total serum cholesterol equal to or lower than 280 mg/100 ml. The influence of elevated total serum cholesterol was in all instances inferior to that of elevated serum glycerides. Smokers showed the frequency of coronary changes the same as or higher than patients with elevated glycerides. The influence of smoking was evident also within classes of low or elevated serum lipids. While all conclusions must be interpreted with reference to the material selected as the source of our data, the importance of smoking as a causative agent independent of serum lipids appears conclusive.

Three hundred and sixty-four workers employed in an accumulator factory had at least three bloodpressure determinations during I962 in a study of the relation between lead exposure and the incidence of hypertension. In this group 46 workers were found to have hypertension; the expected incidence was 5I.Two hundred and seventy-three of the total group, all over 35 years, had been employed for a sufficiently long time to be considered as having had a long-term exposure to lead. On the basis of urinary coproporphyrin tests, they were divided into a 'lead-affected' group (I4I) and a 'non-lead-affected' group (I32). There were 22 persons with hypertension in the former group, and 20 in the latter. There was no significant difference in the appearance of hypertension in these two groups either from the standpoint of age or from the duration of exposure to lead.Two hundred and sixty-five workers had been employed at the factory for IO or more years, and 82 of these for more than 20 years. There was a positive correlation between the incidence of hypertension and the duration of employment, but no difference between the 'lead-affected' and 'non-lead-affected' groups. This observation is understandable in view of the increasing incidence of hypertension with advancing age.The study shows that workers in an accumulator factory, in which the working conditions are inspected and controlled regularly and in which the workers themselves are examined regularly for the influence of lead, are not more prone to hypertension than the general population. In view of the possibility of vascular damage after exposure to lead, blood pressures in lead-workers should be watched, and treatment started early if hypertension is found.

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