Air Quality Criteria for Lead Volume II of II - (NEPIS)(EPA) - US ...

AX6-104
Table AX6-4.3. Renal Effects of Lead in the Patient Population
Reference, Study
Location, and
Period Study Description Pb Measurement Findings, Interpretation
United States
Osterloh et al. (1989)
Northern CA
Study date not
provided
Steenland et al. (1990)
Michigan
Diagnosis from
1976-1984
Europe
Behringer et al.
(1986)
Germany
Study date not
provided
40 male subjects with hypertensive nephropathy
(hypertension preceded renal insufficiency; serum
creatinine 1.8-4 mg/dL).
24 controls with renal dysfunction from other causes.
Patients recruited from the Kaiser Permanente Regional
Laboratory database (large health maintenance
organization) in northern California.
325 men with ESRD (diabetes, congenital and obstructive
nephropathies excluded).
Controls by random digit dialing, matched by age, race,
and place of residence.
16 patients with CRI (median serum creatinine =
2.2 mg/dL) and gout.
19 patients with CRI (median serum creatinine =
5.1 mg/dL) without gout.
21 healthy controls.
Pb excretion in the 96 hrs after administration of 1 g
EDTA iv.
Mean blood Pb
7.3 µg/dL (in both
hypertensive nephropathy and
controls CRI from other
causes)
Mean EDTA chelatable Pb
levels
153.3 µg/72 hrs (hypertensive
nephropathy)
126.4 µg/72 hrs (control CRI)
Median blood Pb
7.2 µg/dL (controls)
11.5 µg/dL (CRI, no gout)
15.3 µg/dL (CRI & gout)
Median EDTA chelatable Pb
(µg/4 days/1.73 m 2 )
63.4 (controls)
175.9 (CRI, no gout)
261.3 (CRI & gout)
No significant difference in EDTA chelatable Pb
levels; highest chelatable Pb level was
609.2 µg/72 hrs.
Pb dose and serum creatinine were not correlated.
Blood and chelatable Pb levels much lower than those
reported by Wedeen et al. (1983) and
Sanchez-Fructuoso et al. (1996).
Only 17% of their study participants had a history of
possible Pb exposure based on questionnaire, again
much lower than the two other studies.
Risk of ESRD significantly related to moonshine
alcohol consumption (OR = 2.43), as well as
analgesic consumption, family history of renal
disease, and occupational exposure to silica or
solvents.
EDTA chelatable Pb higher in gout patients who
developed gout after CRI than those in which gout
preceded CRI (statistical test results not mentioned or
shown). Authors conclude a role for Pb in patients
with gout occurring in setting of CRI and that Pb may
contributes to renal function decline in established
renal disease from other causes.
Limitations = small groups, limited data analysis.