Chapter 22 - Renal effects of exposure to metals

Abstract

Several metals have nephrotoxic properties. In this chapter we discuss various methods for assessing nephrotoxicity, different forms of proteinuria, and methods of estimating the glomerular filtration rate. Metals may affect renal glomeruli, resulting in a decreased glomerular filtration rate, sometimes associated with massive albuminuria. Effects on renal tubular function are more common, affecting the reabsorption of minerals, glucose, amino acids, and low molecular weight proteins from filtered primary urine. Various biomarkers, especially proteinuria, are also discussed. The most important nephrotoxic metals are lead, cadmium, and mercury. Acute nephrotoxic effects are sometimes seen, especially in suicide attempts or as side effects when metals (e.g., gold, platinum, lithium and antimony) are used in treatment of certain diseases. Long-term exposure is more common, e.g., via diet, drinking water, or occupational exposure. For example, long-term exposure to cadmium sometimes causes chronic kidney disease, and in rare cases the development of end-stage renal disease with uremia. Lithium used for treatment of mano-depressive disorders often cause polyuria and sometimes chronic kidney disease.