Melamine nephrotoxicity: an emerging epidemic in an era of globalization

Abstract

Recent outbreaks of nephrolithiasis and acute kidney injury among children in China have been linked to ingestion of milk-based infant formula contaminated with melamine. These cases provide evidence in humans for the nephrotoxicity of melamine, which previously had been described only in animals. The consequences of this outbreak are already severe and will likely continue to worsen. Herein we summarize the global impact of the melamine milk contamination, the reemergence of melamine-tainted animal feed, and potential mechanisms of melamine nephrotoxicity. Large-scale epidemiologic studies are necessary to further characterize this disease and to assess its potential long-term sequelae. This epidemic of environmental kidney disease highlights the morbidity associated with adulterated food products available in today's global marketplace and reminds us of the unique vulnerability of the kidney to environmental insults. Melamine is the latest in a growing list of diverse potentially toxic compounds about which nephrologists and other health-care providers responsible for the diagnosis and management of kidney disease must now be aware.

Urinary tract abnormalities in Chinese rural children who consumed melamine-contaminated dairy products: a population-based screening and follow-up study

“…The potential for long-term complications after exposure to melamine remains a serious concern. 4 An expert panel sponsored by the World Health Organization, the Food and Agriculture Organization of the United Nations and Health Canada recommended long-term follow-up of children with melamine nephrotoxicity. 5 Our results suggest a need for further follow-up of affected children to evaluate the possible long-term impact on health, including renal function.…”

“…[4][5]2009) after the initial screening. The timing of these follow-up visits was based on the guidelines issued by the Ministry of Health.…”

“…[1][2][3][4] On Sept. 12, 2008, the Chinese government announced to the public that the outbreak had occurred and initiated various emergency responses, including the set-up of a high-level national coordinating group, free screening and treatment of affected children, thorough inspection of all dairy products and producers, timely release of information to the public, recalls of contaminated products, suspension of production of the contaminated milk and compensation to the families of affected children. More than 50 000 children have been hospitalized and six have died because of kidney damage.…”

“…7,8 In humans, melaminerelated disease has been recognized only recently, and the full adverse effects of exposure remain unknown. 4,9 A clinicopathologic study suggests that the size of urinary stones is related to melamine concentration. 9 A recent hospital-based study in Beijing reported the prevalence of nephrolithiasis was 8.5% among children who were exposed and referred by other hospitals.…”

Investigation of Melamine Presence in Canned Tuna Fish by Capillary Zone Electrophoresis Method

“…Necrosis of distal tubular cells and mild inflammation are symptoms of melamine-associated acute kidney disease in animals. Larger crystals, interstitial inflammation, and fibrosis occur in chronic toxicity (Bhalla et al 2009).…”