Abstract
BackgroundLong-term exposure of mercury may induce glomerulonephritis. Clinical and pathological features of mercury-associated glomerulonephritis are not fully clear. This study retrospectively analyzed 35 cases of mercury-associated glomerulonephritis in a single Chinese center.MethodsThirty-five patients of mercury-associated glomerulonephritis were enrolled. Clinical data on diagnosis and during follow-up were collected. Plasma anti-phospholipase A2 receptor (PLA2R) antibody, glomerular PLA2R and glomerular IgG subclasses deposition were detected in the cases with membranous nephropathy (MN).ResultsMercury exposure was caused by skin lighting cream (20 patients), mercury-containing pills (9 patients), hair-dyeing agents (4 patients), and unidentified reasons (2 patients). All patients presented with proteinuria and normal renal function. The median of urinary protein was 4.6 (range 1.6~19.7) g/24 h. Twenty-two patients (62.9%) had nephrotic syndrome. Renal histopathology showed minimal change disease (MCD) in 21 patients (60.0%), MN in 13 (37.1%) and focal segmental glomerular sclerosis (FSGS) in 1 patient (2.9%). The proportion of MCD increased along with urinary mercury concentration (P = 0.024). In 13 cases of MN, all patients were negative for plasma anti-PLA2R antibody and glomerular PLA2R antigen. IgG1 (61.5%) and IgG4 (46.2%) deposits were noted along the glomerular capillary loops. Among the 16 patients received mercury detoxification monotherapy, 14 patients received 4.5 ± 2.8 (range 1~12) rounds of regimen and achieved complete remission in 4.5 (range 0.3~23.0) months, 2 patients stayed no remission.ConclusionsMCD was the most common pathological type of mercury-associated glomerulonephritis, followed by MN. The proportion of MCD increased along with the increase of urinary mercury concentration. Most patients could achieve complete remission after mercury detoxification.
Highlights
Long-term exposure of mercury may induce glomerulonephritis
The current study retrospectively reviewed 35 cases of mercury-associated glomerulonephritis over a 6-year period to analyze the clinical and pathological features, treatment and prognosis of this disease
The determination of mercury intoxication was defined according to the diagnostic criteria for occupational mercury poisoning (GBZ89–2002) issued by the government of China, in which, the cut-off value of urinary mercury concentration was at least four times higher than that of the upper limit of 95th percentile of the U.S population from the National Health and Nutrition Examination Survey (NHANES) in 2019 [7]
Summary
Long-term exposure of mercury may induce glomerulonephritis. Clinical and pathological features of mercury-associated glomerulonephritis are not fully clear. This study retrospectively analyzed 35 cases of mercuryassociated glomerulonephritis in a single Chinese center. As early as 1818, there has been a report of proteinuria caused by mercury compounds [2]. Mercury-associated kidney disease has apparently decreased in developed countries, but mercury exposure is still not rare in developing countries [6]. Since lack of specific clinical manifestations, mercury-associated glomerulonephritis is often misdiagnosed as primary. The pathological spectrum and mechanism of mercury-associated glomerulonephritis has not been fully elucidated. The current study retrospectively reviewed 35 cases of mercury-associated glomerulonephritis over a 6-year period to analyze the clinical and pathological features, treatment and prognosis of this disease
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