Satarug Soisungwan, C Gobe Glenda, A Vesey David, Phelps Kenneth R
Kidney Disease Research Collaborative, The University of Queensland Faculty of Medicine and Translational Research Institute, Woolloongabba, Brisbane 4102, Australia.
School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia.
Toxics. 2020 Oct 13;8(4):86. doi: 10.3390/toxics8040086.
The present review aims to provide an update on health risks associated with the low-to-moderate levels of environmental cadmium (Cd) and lead (Pb) to which most populations are exposed. Epidemiological studies examining the adverse effects of coexposure to Cd and Pb have shown that Pb may enhance the nephrotoxicity of Cd and vice versa. Herein, the existing tolerable intake levels of Cd and Pb are discussed together with the conventional urinary Cd threshold limit of 5.24 μg/g creatinine. Dietary sources of Cd and Pb and the intake levels reported for average consumers in the U.S., Spain, Korea, Germany and China are summarized. The utility of urine, whole blood, plasma/serum, and erythrocytes to quantify exposure levels of Cd and Pb are discussed. Epidemiological studies that linked one of these measurements to risks of chronic kidney disease (CKD) and mortality from common ailments are reviewed. A Cd intake level of 23.2 μg/day, which is less than half the safe intake stated by the guidelines, may increase the risk of CKD by 73%, and urinary Cd levels one-tenth of the threshold limit, defined by excessive ß-microglobulin excretion, were associated with increased risk of CKD, mortality from heart disease, cancer of any site and Alzheimer's disease. These findings indicate that the current tolerable intake of Cd and the conventional urinary Cd threshold limit do not provide adequate health protection. Any excessive Cd excretion is probably indicative of tubular injury. In light of the evolving realization of the interaction between Cd and Pb, actions to minimize environmental exposure to these toxic metals are imperative.
本综述旨在提供有关大多数人群所接触的低至中等水平环境镉（Cd）和铅（Pb）相关健康风险的最新信息。研究镉和铅共同暴露不良影响的流行病学研究表明，铅可能会增强镉的肾毒性，反之亦然。本文讨论了镉和铅现有的可耐受摄入量水平，以及传统的尿镉阈值限制5.24μg/g肌酐。总结了镉和铅的膳食来源以及美国、西班牙、韩国、德国和中国普通消费者报告的摄入量水平。讨论了尿液、全血、血浆/血清和红细胞在量化镉和铅暴露水平方面的作用。回顾了将这些测量指标之一与慢性肾脏病（CKD）风险和常见疾病死亡率相关联的流行病学研究。每天23.2μg的镉摄入量低于指南规定的安全摄入量的一半，可能会使CKD风险增加73%，而尿镉水平为阈值限制的十分之一（由过量β-微球蛋白排泄定义）与CKD风险增加、心脏病死亡率、任何部位癌症和阿尔茨海默病相关。这些发现表明，目前镉的可耐受摄入量和传统的尿镉阈值限制并不能提供足够的健康保护。任何过量的镉排泄可能都表明肾小管损伤。鉴于对镉和铅之间相互作用的认识不断发展，必须采取行动尽量减少环境中对这些有毒金属的暴露。
