Abstract
BackgroundIn health examinations for local inhabitants in cadmium-polluted areas, only healthy people are investigated, suggesting that patients with severe cadmium nephropathy or itai-itai disease may be overlooked. Therefore, we performed hospital-based screening to detect patients with cadmium nephropathy in two core medical institutes in cadmium-polluted areas in Akita prefecture, Japan.MethodsSubjects for this screening were selected from patients aged 60 years or older with elevated serum creatinine levels and no definite renal diseases. We enrolled 35 subjects from a hospital in Odate city and 22 from a clinic in Kosaka town. Urinary ß2-microglobulin and blood and urinary cadmium levels were measured.ResultsThe criteria for renal tubular dysfunction and the over-accumulation of cadmium were set as a urinary ß2-microglobulin level higher than 10,000 μg/g cr. and a blood cadmium level higher than 6 μg/L or urinary cadmium level higher than 10 μg/g cr., respectively. Subjects who fulfilled both criteria were diagnosed with cadmium nephropathy. Six out of 57 patients (10.5% of all subjects) had cadmium nephropathy.ConclusionsThis hospital-based screening is a very effective strategy for detecting patients with cadmium nephropathy in cadmium-polluted areas, playing a complementary role in health examinations for local inhabitants.Registration numberNo. 6, date of registration: 6 June, 2010 (Akita Rosai Hospital), and No. 1117, date of registration: 26 December, 2013 (Akita University).
Highlights
In health examinations for local inhabitants in cadmium-polluted areas, only healthy people are investigated, suggesting that patients with severe cadmium nephropathy or itai-itai disease may be overlooked
The excessive exposure of local inhabitants to cadmium stopped after the restoration of polluted rice fields was completed in 2011, it is estimated that new patients with itai-itai disease as well as cadmium nephropathy will continue to occur in the future
There is no established threshold of blood cadmium to induce cadmium nephropathy; we provisionally selected 6 μg/L in the present study based on the relationship between blood and urinary cadmium levels among 1464 female farmers in the same areas who were healthy examinees in a previous study [5], in which we selected 5.7 μg/L of blood cadmium (y) by substituting 10 μg/g cr. of urinary cadmium (x) into their regression equation: y = 0.396x + 1.692
Summary
In health examinations for local inhabitants in cadmium-polluted areas, only healthy people are investigated, suggesting that patients with severe cadmium nephropathy or itai-itai disease may be overlooked. There are several cadmium-polluted areas in Japan attributed to slags, waste fluids, or emissions from local mines or smelters [4]. The inhabitants of these areas, farmers, are at risk of excessive oral exposure to cadmium through the life-long consumption of locally produced rice, which results in the development of cadmium nephropathy [5]. The excessive exposure of local inhabitants to cadmium stopped after the restoration of polluted rice fields was completed in 2011, it is estimated that new patients with itai-itai disease as well as cadmium nephropathy will continue to occur in the future.
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