Chronic renal failure with gout: A marker of chronic lead poisoning

Abstract

EDTA (calcium disodium edetate) lead mobilization and x-ray fluorescence (XRF) finger bone lead tests were done in 42 patients with chronic renal failure and without persisting lead intoxication. Nineteen of 23 patients with gout and 8 of 19 without gout had positive EDTA lead mobilization tests. Those patients with gout excreted significantly more excess lead chelate than those without gout. In the gout group 17 patients denied any childhood or industrial exposure to lead. They had a greater number of positive tests and excreted significantly more excess lead chelate than 14 patients with neither gout nor lead exposure. These results confirm that gout in the presence of chronic renal failure is a useful marker of chronic lead poisoning. Of 27 patients with positive lead mobilization tests, only 13 had elevated XRF finger bone lead concentrations (sensitivity 48%). Three of 15 patients with negative lead mobilization tests had elevated XRF finger bone lead concentrations (specificity 80%). Although the XRF finger bone lead test is a convenient noninvasive addition to the diagnostic evaluation of patients with chronic renal failure and gout, its application is limited due to the lack of sensitivity of the method.

Chelated lead and bone lead.

“…However, if we exclude both the retired worker and the one removed from active lead work (on the grounds that the lead distribution between different pools may have been different from that of currently active workers), then the correlation between calcaneus and chelated lead, for example, increases significantly, to r = 0.62 (N = 18). Recently, rather poor associations were reported between CaNa 2EDTA-chelated lead on one hand and either finger lead in patients with renal impairment (29) or tibia lead in lead workers (13) on the other, while there was a rather good correlation with lead in ileum biopsies (15).…”

Lead Nephropathy - A Preventable Cause of Renal Failure

“…Radiological demonstration of 'lead lines' at metaphyseal ends of bone are rarely seen. X-ray fluorescence is not a sensitive test for lead intoxication (28). Hair lead concentration greater than 80 Jig/g may indicate toxicity but may be influenced by other factors such as hair colour and age.…”

Disappearance of Immune Deposits with EDTA Chelation Therapy in a Case of IgA Nephropathy

“…The rapid clearance of proteinuria and the mild improvement of serum creati nine and creatinine clearance after the chelation therapy implicate an increased lead burden in the pathogenesis of renal dysfunction. Although slightly elevated blood lead levels have been demonstrated in patients with renal fail ure, most authors failed to find elevated urinary lead excretion [11,12] or bone lead [13]. The post-EDTA uri nary lead excretion of our patient was 744.95 pg and hence less likely to be a consequence of renal failure.…”