Glomerular function of lead-exposed workers

Chia, K S; Jeyaratnam, J; Tan, Chew-Lim; Ong, Hui Ting; Ong, Choon‐Nam; Lee, E.

doi:10.1016/0378-4274(95)03313-0

Cited by 18 publications

(8 citation statements)

References 25 publications

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“…Chia et al (62) studied renal functional parameters in 137 lead-exposed workers [PbB <60 pg/dl (<2.89 pmol/l)] and in 153 control postal workers. The mean creatinine clearances were not different between the two groups.…”

Section: Lead Nephropathymentioning

confidence: 99%

Renal effects of environmental and occupational lead exposure.

Loghman‐Adham

1997

Environ Health Perspect

252

122

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Environmental and industrial lead exposures continue to pose major public health problems in children and in adults. Acute exposure to high concentrations of lead can result in proximal tubular damage with characteristic histologic features and manifested by glycosuria and aminoaciduria. Chronic occupational exposure to lead, or consumption of illicit alcohol adulterated with lead, has also been linked to a high incidence of renal dysfunction, which is characterized by glomerular and tubulointerstitial changes resulting in chronic renal failure, hypertension, hyperuricemia, and gout. A high incidence of nephropathy was reported during the early part of this century from Queensland, Australia, in persons with a history of childhood lead poisoning. No such sequela has been found in studies of three cohorts of lead-poisoned children from the United States. Studies in individuals with low-level lead exposure have shown a correlation between blood lead levels and serum creatinine or creatinine clearance. Chronic low-level exposure to lead is also associated with increased urinary excretion of low molecular weight proteins and lysosomal enzymes. The relationship between renal dysfunction detected by these sensitive tests and the future development of chronic renal disease remains uncertain. Epidemiologic studies have shown an association between blood lead levels and blood pressure, and hypertension is a cardinal feature of lead nephropathy. Evidence for increased body lead burden is a prerequisite for the diagnosis of lead nephropathy. Blood lead levels are a poor indicator of body lead burden and reflect recent exposure. The EDTA lead mobilization test has been used extensively in the past to assess body lead burden. It is now replaced by the less invasive in vivo X-ray fluorescence for determination of bone lead content.Imagesp928-aFigure 1.Figure 2.Figure 2.Figure 3.

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Section: Lead Nephropathymentioning

confidence: 99%

Renal effects of environmental and occupational lead exposure.

Loghman‐Adham

1997

Environ Health Perspect

252

122

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“…Also, we determined a-1CR and urine albumine to urine creatinine ratio in a single spot urine sample. However, recent studies suggest that similar measurements of a-1CR are a reliable marker for EN (23,25,(39)(40)(41)(42)(43)(44)(45) and other chronic tubulointerstitial diseases, such as cadmium nephropathy (46)(47)(48)(49). Most authors believe that a-1 microglobulin has advantages over b-2 microglobulin.…”

Section: Discussionmentioning

confidence: 99%

Chronic Dietary Exposure to Aristolochic Acid and Kidney Function in Native Farmers from a Croatian Endemic Area and Bosnian Immigrants

Jelaković

Lela

Karanović

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Improvements in agricultural practices in Croatia have reduced exposure to consumption of aristolochic acid-contaminated flour and development of endemic (Balkan) nephropathy. Therefore, it was hypothesized that Bosnian immigrants who settled in an endemic area in Croatia 15-30 years ago would be at lower risk of developing endemic nephropathy because of reduced exposure to aristolochic acid. To test this hypothesis, past and present exposure to aristolochic acid, proximal tubule damage as a hallmark of endemic nephropathy, and prevalence of CKD in Bosnian immigrants were analyzed.Design, setting, participants, & measurements In this cross-sectional observational study from 2005 to 2010, 2161 farmers were divided into groups: indigenous inhabitants from endemic nephropathy and nonendemic nephropathy villages and Bosnian immigrants; a-1 microglobulin-to-creatinine ratio .31.5 mg/g and eGFR,60 ml/min per 1.73 m 2 were considered to be abnormal.Results CKD and proximal tubule damage prevalence was significantly lower in Bosnian immigrants than inhabitants of endemic nephropathy villages (6.9% versus 16.6%; P,0.001; 1.3% versus 7.3%; P=0.003, respectively); 20 years ago, Bosnian immigrants observed fewer Aristolochia clematitis in cultivated fields (41.9% versus 67.8%) and fewer seeds among wheat seeds (6.1% versus 35.6%) and ate more purchased than homemade bread compared with Croatian farmers from endemic nephropathy villages (38.5% versus 14.8%, P,0.001). Both Croatian farmers and Bosnian immigrants observe significantly fewer Aristolochia plants growing in their fields compared with 15-30 years ago. Prior aristolochic acid exposure was associated with proximal tubule damage (odds ratio, 1.64; 95% confidence interval, 1.04 to 2.58; P=0.02), whereas present exposure was not (odds ratio, 1.31; 95% confidence interval, 0.75 to 2.30; P=0.33). Furthermore, immigrant status was an independent negative predictor of proximal tubule damage (odds ratio, 0.40; 95% confidence interval, 0.19 to 0.86; P=0.02).Conclusions Bosnian immigrants and autochthonous Croats residing in endemic areas are exposed significantly less to ingestion of aristolochic acid than in the past. The prevalence of endemic nephropathy and its associated urothelial cancers is predicted to decrease over time.

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“…12 It has the advantage over beta2-MG because it is stable at a low pH. 21 Alpha1-MG has already been shown as a marker of renal tubular dysfunction not only in heavy metal poisoning, 22,23 multiple myeloma, 24 diabetes, 25 but also in BEN. 11 As urinary beta2-MG has been widely advocated as a sensitive indicator of tubular proteinuria in BEN and, on the other side, there is no study that compares diagnostic potential of beta2-MG and alpha1-MG, it seems needful to undertake the study to answer the question: which of these two urinary markers is a more reliable marker of BEN?…”

Section: Discussionmentioning

confidence: 99%

Beta2-Microglobulin and Alpha1-Microglobulin as Markers of Balkan Endemic Nephropathy, a Worldwide Disease

Stefanović

Djukanović²,

Čukuranović

et al. 2011

Renal Failure

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Background: Urine beta2-microglobulin (beta2-MG) was mainly used as a tubular marker of Balkan endemic nephropathy (BEN) but recently alpha1-microglobulin (alpha1-MG) was proposed for the diagnosis of BEN. In this study, the potential of urine beta2-MG, alpha1-MG, albumin, and total protein in the differentiation of BEN from healthy persons and patients with glomerulonephritis (GN) and nephrosclerosis (NS) was examined. Methods: This study involved 47 patients with BEN, 36 with GN, 11 with NS, 30 healthy subjects from BEN families, and 46 healthy subjects from non-BEN families. Results: In BEN patients area under the curve (AUC) for urine beta2-MG (0.828) and alpha1-MG (0.782) was higher than for urine albumin (0.740), but in GN patients AUC for urine protein (0.854) and albumin (0.872) was significantly higher than for the two low molecular weight proteins. AUC for all four urinary markers in NS patients was significantly lower than in BEN patients, ranging between 500 and 595. Median urine beta2-MG excretion in BEN patients was 17.5 times higher than in GN patients and 18.3 times higher than in controls; median alpha1-MG excretion was higher only 3.0 and 2.25 times, respectively. In the differentiation of BEN from healthy controls, beta2-MG had higher sensitivity and specificity at the cutoff levels (p < 0.001) than alpha1-MG (p < 0.05). In the differentiation of BEN from GN, beta2-MG was the best marker. Conclusion: All four urinary markers can be used for the differential diagnosis of BEN, beta2-MG being the best. Like in aristolochic acid nephropathy, beta2-MG seems to be an early marker of tubular damage in BEN.

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Glomerular function of lead-exposed workers

Cited by 18 publications

References 25 publications

Renal effects of environmental and occupational lead exposure.

Renal effects of environmental and occupational lead exposure.

Chronic Dietary Exposure to Aristolochic Acid and Kidney Function in Native Farmers from a Croatian Endemic Area and Bosnian Immigrants

Beta2-Microglobulin and Alpha1-Microglobulin as Markers of Balkan Endemic Nephropathy, a Worldwide Disease

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