Nephrology Dialysis Transplantation, Vol 13, Issue 9 2248-2256, Copyright © 1998 by Oxford University Press
L Fels, M Wunsch, J Baranowski, I Norska-Borowka, R Price, S Taylor, S Patel, M De Broe, M Elsevier, R Lauwerys, H Roels, A Bernard, A Mutti, E Gelpi, J Rosello and H Stolte
Background: Children have been considered a risk group
for lead (Pb) toxicity, mainly because of neurophysiological or
neuro-cognitive deficits following Pb exposure. Blood Pb levels (b-Pb) of
100 &mgr;g/l currently have been defined as the lowest adverse effect
level. The aim of this study was to compare, with the help of urinary
markers, the kidney function of children with b-Pb just above this
threshold with that of unexposed children, to assess from a nephrological
point of view whether the current threshold is justified and whether
children really are a particularly vulnerable risk group in terms of
Pb-induced kidney damage. Methods: In a
cross-sectional study, 112 children, either from unexposed areas (controls,
n=50) or Pb-contaminated areas (n=62), the latter partly with a known
history of elevated b-Pb, were examined. Twenty nine urinary or serum
markers mostly related to the function or integrity of specific nephron
segments were determined (e.g. filtered plasma proteins, tubular enzymes,
tubular antigens, eicosanoids). Results: b-Pb were
89±13 &mgr;g/l in controls and 133±62
&mgr;g/l in exposed children. The main findings were increased
excretion rates of prostaglandins and thromboxane B2, epidermal growth
factor, {beta}2-microglobulin and Clara cell protein in the exposed
children. A relationship between b-Pb and the prevalence of values above
the upper reference limits was observed. Conclusions:
With the help of urinary markers, nephron segment-specific effects of
chronic low-level Pb exposure could be detected in children. The pattern of
effects on glomerular, proximal and distal tubular and interstitial markers
was similar to that previously observed in adults. The changes, however,
occur at lower b-Pb levels than in adults. The current threshold appears to
be justified also from a nephrological point of view, and children can
indeed be considered a special risk group. Key words:
children; Clara cell protein; EGF; eicosanoids; glomerular and tubular
function; lead exposure
ORIGINAL ARTICLES
Adverse effects of chronic low level lead exposure on kidney function-a risk group study in children
Division of Nephrology, Medical School Hannover, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; Silesian Medical Academy, Zabrze, Poland; Division of Biomolecular Sciences, Biochemistry Section, King's College London, UK; Department of Nephrology-Hypertension, University of Antwerp, Edegem-Antwerp, Belgium; Unité de Toxicologie Industrielle et Médicine du Travail, Université Catholique de Louvain, Brussels, Belgium; Laboratory of Industrial Toxicology, University of Parma Medical School, Parma, Italy; Department of Biomedical Analysis, Unit of Molecular Pathology and Biochemistry of Inflammation, CSIC, Barcelona, Spain; Corresponding author
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