Dumitriu, Ana Roventa Clinic of Occupational Diseases, Institutul de Igienă, Bucharest, Roumania Abstract This paper presents a study of renal function in 102 patients with lead poisoning admitted to the Occupational Diseases Clinic in Bucharest during [oem.bmj.com]

Part II presents an over public are concerned about the adverse effects of view of chemical and physical agents commonly toxic agents found in contaminated air, water, food, found in contaminated air, water, food, and soil. and soil. [books.google.com]

Alternatively, it may develop over several years - presenting with hypertension and proteinuria sometimes. Ciclosporin This can cause acute and chronic nephrotoxicity. [patient.info]

The renal evaluation of patients thought to have renal disease associated with an environmental or occupational exposure should be guided by the history, physical examination, and clinical presentation of the renal disease. [accessmedicine.mhmedical.com]

• Inflammation

  […] histologic) description Tubular atrophy and interstitial fibrosis Tubular inclusions are eosinophilic and intranuclear or cytoplasmic, acid-fast and red with Giemsa stain Arteriolar disease similar to nephrosclerosis Tubules disappear in chronic disease; no inflammation [pathologyoutlines.com]

  Blood lead levels, malnutrition, inflammation, and mortality in patients with diabetes treated by long-term hemodialysis. Am J Kidney Dis 2008;51:107-115. Lin JL, Lin-Tan DT, Chen KH, et al. [medigraphic.com]

  This is renal failure associated with inflammation of the renal interstitium, ie the area of the kidney between the nephrons. [patient.info]

  Non-inflammatory injury : Common examples of this include the podocytopathies; minimal change nephrotic syndrome/focal segmental glomerulosclerosis (MCNS/FSGS) and membranous nephropathy (MN) A dramatic rise in the glomerular permeability without any evidence of inflammation [pathophys.org]

  Inflamm Bowel Dis. vol. 13. 2007. pp. 629-638. Urate Nephropathy Bellomo, G, Venzanzi, S, Verdura, C, Saronio, P, Esposito, A, Timio, M. “Association of uric acid with changes in kidney function in healthy normotensive individuals”. [renalandurologynews.com]

• Weight Loss

  […] proteinuria, slow reduction in GFR Aristolochic acid nephropathy (Chinese herbal nephropathy) Chinese herbal preparations (made of Aristolochia plant, traditional Chinese names: Mu Tong, Fang Ji) that contain aristolochic acid (nephrotoxic alkaloid; used for weight [empendium.com]

  Idiopathic - found associated with anterior uveitis or iritis (tubulointerstitial nephritis with uveitis (TINU)) syndrome affecting mainly young women and girls - fever, weight loss and renal failure. [ 9 ] Presenting features Sudden onset acute kidney [patient.info]

  Weight loss Loss of lean body mass Protein-energy malnutrition due to metabolic acidosis. Loss of kidney function results in impaired H+ secretion from the body. [pathophys.org]

  Symptoms of Chronic Lead Toxicity: • Then complicated with - Intermittent abdominal cramping, vomiting, and constipation - Loss of appetite and diminished libido - Weight loss and anemia and increase in systolic blood pressure. - Tremors and peripheral [slideshare.net]

  Have swelling and weight gain from fluid buildup in your tissues (edema). Feel very tired. Lose your appetite or have an unexpected weight loss. Feel nauseated or vomit. Be either very sleepy or unable to sleep. [northshore.org]

• Falling

  Rejecting or recoding measurements that fall below an instrument’s MDL can yield results that are artificially biased ( 34 ). [clinchem.aaccjnls.org]

  When kidney function falls below a certain point, it is called kidney failure. Kidney failure has harmful effects throughout your body. It can cause serious heart, bone, and brain problems and make you feel very ill. [northshore.org]

  […] concentrating mechanism located in the medulla Occurs early in the course Associated: nocturia, polyuria and nephrogenic diabetes insipidus (NDI) with complications of dehydration Sodium wasting Difficulties in reabsorbing salt, leading to a reversible fall [renalandurologynews.com]

• Abdominal Pain

  Clinical presentation • Nausea, persistent vomiting, diarrhea, and abdominal pain are the hallmark of most acute metal ingestions. • Dehydration is common. [slideshare.net]

  Findings consisted of recurrent abdominal pain and grayish discoloration of the gingival tooth border consistent with 'lead line', with elevated blood lead level. [sjkdt.org]

  Other clinical manifestations include haemolytic anaemia, acute attacks of gout, intense abdominal pain (“painter’s colic”) and encephalopathy. 43 Diagnosing chronic nephritis due to Pb is difficult, since urinary symptoms and findings are variable and [revistanefrologia.com]

  Clinical Presentation: Acute intoxication More common in children Abdominal pain, Neurologic symptoms and Pallor (microcytic anemia) Associated Fanconi’s syndrome Renal biopsy: acid-fast granular intranuclear inclusions (myeloid bodies) in the proximal [renalandurologynews.com]

• Loss of Appetite

  When symptoms of kidney damage do occur, they may include significantly decreased urine production, swelling in the lower legs and ankles, hypertension, loss of appetite, muscle cramps, fatigue, digestive upset, and dry, itchy skin. [larcusa.org]

  Symptoms of Chronic Lead Toxicity: • Then complicated with - Intermittent abdominal cramping, vomiting, and constipation - Loss of appetite and diminished libido - Weight loss and anemia and increase in systolic blood pressure. - Tremors and peripheral [slideshare.net]

  Call your doctor immediately if you: Have symptoms of uremic syndrome, such as increasing fatigue, nausea and vomiting, loss of appetite, or inability to sleep. Vomit blood or have blood in your stools. [northshore.org]

• Hypertension

  Lead-induced hypertension: Role of oxidative stress. Curreent Hypertension Reports 2004; 6: 314-320. CrossRef Google Scholar 40. Staessen J, Lauwerys RR, Buchet J-P, Bulpitt CJ, Rondia D, Vanenterghem Y, Amery A. [link.springer.com]

  Gout is actually quite rare in other forms of CKD, so the appearance of gout and CKD together should prompt screening for serum lead levels. 3. lead-induced hypertension--lead can lead to renal disease indirectly by causing hypertension--a finding which [renalfellow.blogspot.com]

  Hypertension, of relatively new onset, is present in most patients. Lead and hypertension Epidemiologic evidence has linked hypertension with lead poisoning. [emedicine.medscape.com]

  Type or etiology Causes/risk factors Features Analgesic nephropathy Excessive analgesic use >3 y in various combinations, including NSAIDs; more frequent in women Hypertension, nocturia, sterile leukocyturia, hemolytic anemia; characteristic papillary [empendium.com]

  Arterial hypertension accompanied the chronic renal failure in 13 patients, the renal impairment generally preceding the rise in blood pressure by several years. [oem.bmj.com]

• Skin Disease

  […] reduction in GFR Aristolochic acid nephropathy (Chinese herbal nephropathy) Chinese herbal preparations (made of Aristolochia plant, traditional Chinese names: Mu Tong, Fang Ji) that contain aristolochic acid (nephrotoxic alkaloid; used for weight loss or skin [empendium.com]

• Seizure

  The effects of lead poisoning on the brain include delayed or reversed development, permanent learning disabilities, seizures, coma, and even death. [slideshare.net]

  When the blood lead level exceeds 150 μg/dL, encephalopathy is common and may be accompanied by fatal seizures. [emedicine.medscape.com]

• Renal Insufficiency

  Measurements: The reciprocal of serum creatinine (1/Cr) was used as an index of progressive renal insufficiency. [annals.org]

  Repeated chelation therapy may improve renal function and slow the progression of renal insufficiency. [nejm.org]

  However, chronic low-level exposure may cause renal insufficiency and hypertension independent of tubulointerstitial disease. [merckmanuals.com]

  The patient was prescribed angiotensinconverting-enzyme inhibitors to slow the progression of renal insufficiency and control the blood pressure. Hyperuricemia was also treated and controlled. [sjkdt.org]

  The patient was prescribed angiotensin-converting-enzyme inhibitors to slow the progression of renal insufficiency and control the blood pressure. Hyperuricemia was also treated and controlled. [ncbi.nlm.nih.gov]

• Kidney Failure

  Treatment for kidney failure When your kidney function has fallen below a certain point, it is called kidney failure. Kidney failure has harmful effects throughout your body. [northshore.org]

  Acute kidney failure. Available online at http://www.mayoclinic.com/health/kidney-failure/DS00280. Accessed March 2014. Mayo Clinic. Nephrotic syndrome. [labtestsonline.it]

  failure that is prevalent in the former Yugoslavia. [medicine.academic.ru]

  failure, bland urinalysis, unremarkable renal US; strong family history of ESRD in patients in their 30s-60s with history of gout favors diagnosis of MCKD 2 (MCKD 2 results from mutations in UMOD gene encoding uromodulin; MCKD 1, from mutations in mucin [empendium.com]

  Kidney Failure Once kidneys fail, dialysis is necessary. The person must choose whether to continue with dialysis or to get a kidney transplant. This choice should be made as a team effort. [diabetes.org]

• Renal Injury

  Arch Environ Health 24, 364-369, 1972 被引用文献1件 10 Renal effects of environmental and occupational lead exposure LOGHMA-ADHAM M. [ci.nii.ac.jp]

  Biomarkers such as alpha 1-microglobulin, NGAL and KIM-1 are useful for detecting early renal injury. Figure 1. Physiopathological mechanisms of cadmium-induced kidney injury Figure 2. [revistanefrologia.com]

  injury through several pathways. [sjkdt.org]

• Nocturia

  Type or etiology Causes/risk factors Features Analgesic nephropathy Excessive analgesic use >3 y in various combinations, including NSAIDs; more frequent in women Hypertension, nocturia, sterile leukocyturia, hemolytic anemia; characteristic papillary [empendium.com]

  Urinary concentration defects (secondary to dysfunction of the kidney concentrating mechanism located in the medulla Occurs early in the course Associated: nocturia, polyuria and nephrogenic diabetes insipidus (NDI) with complications of dehydration Sodium [renalandurologynews.com]

Acute Kidney Injury Workup. Medscape Reference. Available online at http://emedicine.medscape.com/article/243492-workup#c13. Accessed May 2016. (April 2014) Seaborg E. New Biomarkers Offer Hope for Identifying Acute Kidney Injury Risk. [labtestsonline.it]

• Hyperuricemia

  Hyperuricemia was also treated and controlled. During the regular follow-up, renal function remained stable with no proteinuria. [ncbi.nlm.nih.gov]

  Short-term lead exposure causes proximal tubular dysfunction, including decreased urate secretion and hyperuricemia (urate is the substrate for saturnine gout), aminoaciduria, and renal glucosuria. [merckmanuals.com]

  Lead exposure is also believed to contribute to “saturnine gout,” which may develop because of lead-induced hyperuricemia due to decreased renal excretion of uric acid. [larcusa.org]

  […] refineries) Serum lead may not be elevated but urinary lead excretion (>0.6 mg/d after IV infusion of sodium versenate) is evidence of increased lead burden; high serum uric acid, gout (~50%) Uric acid (gouty) nephropathy Long-standing inconsistently treated hyperuricemia [empendium.com]

• Uric Acid Increased

  Mean serum uric acid was 7.9 ± 2.1 mg/dL (Allopurinol Treated Group) versus 7.3 ± 1.6 mg/dL (Usual Treated Group) Serum uric acid decreased with Allopurinol (7.8→ 6 mg/dL) The Allopurinol Treated Group had an INCREASE in eGFR by 1.3 ml/min/1.73m 2 versus [renalandurologynews.com]

No Doctor/Patient relationship shall be deemed to have arisen simply by reading the information contained on these pages, and you should consult with your personal physician/care giver regarding your medical treatment before undergoing any sort of treatment [drcalapai.net]

After the 2-month treatment period, improvement in renal function was greater in the treatment group than in the control group. [annals.org]

Think about your treatment options and which kind of treatment will be best for you. [northshore.org]

Treatment includes: Counseling Penile implant or injections Vacuum erection device Medication In Women : Symptoms include: Can include less vaginal lubrication and fewer or no orgasms. What you should do: See your doctor. [webmd.com]

Treatments for Kidney Disease Self-care Important treatments for kidney disease are tight control of blood glucose and blood pressure. Blood pressure has a dramatic effect on the rate at which the disease progresses. [diabetes.org]

Prognosis Renal function stabilises or improves slightly on discontinuation of analgesics in early cases. [patient.info]

[…] diagnosis of CKD requires the following: Decline of kidney function for 3 months or more AND Evidence of kidney damage (e.g. albuminuria or abnormal biopsy) OR GFR 2 Each patient is classified into one of the following 5 stages of CKD because management and prognosis [pathophys.org]

Prognosis: Rapid progression to ESRD (6 months — 2 years) CLINICAL PEARL: High prevalence of Urothelial Malignancies (40-50%) of: Upper urinary tract (multifocal high-grade transitional cell carcinoma) and bladder ** Most commonly detected in pts with [renalandurologynews.com]

The etiology of the kidney injury in a significant percentage of these patients is never fully elucidated, and the diagnosis of renal disease of occupational origin is rarely considered. [accessmedicine.mhmedical.com]

Type or etiology Causes/risk factors Features Analgesic nephropathy Excessive analgesic use >3 y in various combinations, including NSAIDs; more frequent in women Hypertension, nocturia, sterile leukocyturia, hemolytic anemia; characteristic papillary [empendium.com]

Global dimensions of chronic kidney disease of unknown etiology (CKDu): a modern era environmental and/or occupational nephropathy? BMC Nephrology 2015;16:145. Gerhardsson L, Lundström NG, Nordberg G, Wall S. [medigraphic.com]

[…] increased GFR (>90 mL/min/1.73 m 2 ) Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m 2 ) Stage 3: Moderate reduction in GFR (30-59 mL/min/1.73 m 2 ) Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m 2 ) Stage 5: Kidney failure (GFR 2 or dialysis) Etiology [pathophys.org]

[…] in only a small proportion of patients Renal biopsy – granulomatous inflammatory infiltrate is confined to the cortex (versus drug-induced interstitial nephritis, predilection for corticomedullary junction (Figure 2) Need to consider other potential etiologies [renalandurologynews.com]

Am J Epidemiology 2002; 156(12):1079-1087 CrossRef Google Scholar 57. Vigeh M, Ghazizadeh S, Yokayama K, Sakai T, Mazaheri M, Morita Y, Beheshti S, Kitamura F, Araki S. [link.springer.com]

This metal gradually accumulates in the body and levels increase with age given its long half-life, which is more than 20 years. 7 Epidemiology Various epidemiological studies have demonstrated that environmental exposure to Cd increases the risk of developing [revistanefrologia.com]

[…] other forms of CKD, so the appearance of gout and CKD together should prompt screening for serum lead levels. 3. lead-induced hypertension--lead can lead to renal disease indirectly by causing hypertension--a finding which has been confirmed in numerous epidemiologic [renalfellow.blogspot.com]

Epidemiology United States statistics Toxic nephropathies are estimated to cause fewer than 1% of all cases of end-stage kidney disease. [emedicine.medscape.com]

Treatment of low-level data varies depending on whether they are intended for use in a clinical setting or for epidemiological research. [clinchem.aaccjnls.org]

Each disease-oriented section begins with an up-to-date review of pathophysiology and then focuses on specific diseases. [books.google.com]

These factors help to explain the pathophysiologic mechanisms involved in certain toxins. For example, lead and cadmium cause much of their renal ultrastructural damage in the proximal tubule, where two-thirds of the filtered load is reabsorbed. [accessmedicine.mhmedical.com]

Pathophysiology • The pathophysiology of the heavy metal remains relatively constant. • For the most part, heavy metals bind to oxygen, nitrogen, and sulfhydryl groups in proteins, resulting in alterations of enzymatic activity. • Nearly all organ systems [slideshare.net]

Pathophysiology Nephrol Dial Transplant. 2002 May;17(5):723-31 Semin Neurol. 2011 Apr;31(2):139-43 Lancet. 2012 Jan 14;379(9811):165-80 Patients with stages 1-3 ([GFR] >30 mL/min) of CKD are generally asymptomatic; water/electrolyte imbalances or endocrine [pathophys.org]

The sharing of in- cus our preventative techniques on the individuals tellectual resources fostered by this effort should and most likely to gain the greatest benefit. [books.google.com]

Primary prevention of lead exposure is the most important and significant strategy to protect children and adults from lead exposures. [atsdr.cdc.gov]

The American Public Health Association, Recognizing that exposure to lead is universal as a result of human-caused disturbances in the natural distribution of lead, and that elevation in the body burden of lead is one of the most prevalent causes of preventable [apha.org]

However, these exposures represent potentially preventable causes of chronic kidney disease. [accessmedicine.mhmedical.com]

The first step in preventing the harm caused by lead is understanding the various ways lead can enter one’s system. [blogs.commons.georgetown.edu]