Loghman-Adham M
Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
Environ Health Perspect. 1997 Sep;105(9):928-38. doi: 10.1289/ehp.97105928.
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.
环境和工业铅暴露继续对儿童和成人构成重大的公共卫生问题。急性高浓度铅暴露可导致近端肾小管损伤，具有特征性组织学表现，并表现为糖尿和氨基酸尿。慢性职业性铅暴露，或饮用掺有铅的非法酒精饮料，也与肾功能障碍的高发病率有关，其特征是肾小球和肾小管间质改变，导致慢性肾衰竭、高血压、高尿酸血症和痛风。在本世纪初，澳大利亚昆士兰州报告了有儿童期铅中毒病史的人群中肾病的高发病率。在美国对三组铅中毒儿童的研究中未发现此类后遗症。对低水平铅暴露个体的研究表明，血铅水平与血清肌酐或肌酐清除率之间存在相关性。慢性低水平铅暴露还与低分子量蛋白质和溶酶体酶的尿排泄增加有关。通过这些敏感测试检测到的肾功能障碍与慢性肾病未来发展之间的关系仍不确定。流行病学研究表明血铅水平与血压之间存在关联，高血压是铅肾病的主要特征。体内铅负荷增加的证据是诊断铅肾病的先决条件。血铅水平是体内铅负荷的不良指标，反映的是近期暴露情况。过去广泛使用依地酸铅动员试验来评估体内铅负荷。现在它已被侵入性较小的体内X射线荧光法所取代，用于测定骨铅含量。
