Severe lead-induced peripheral neuropathy in a dialysis patient

Toxic neuropathy caused by lead (manifested as wrist drop) was a frequent phenomenon before 1925. In modern times, it is a distinct rarity. We report herein a Hispanic woman who developed end-stage renal failure, followed by wrist drop, in whom the maximal total blood lead was 69 microg/dL. Measurements of lead in her tibia and calcaneus by K-x-ray fluorescence, however, showed markedly elevated values. The wrist drop cleared after four treatments with intravenous calcium sodium edetate (Ca EDTA). In vitro studies of (210)Pb uptake by red blood cells (RBC) after incubation with normal or uremic plasma indicated that (210)Pb uptake was inhibited by uremic plasma. These studies suggest the presence of a transport inhibitor in uremia that modifies the distribution of lead between plasma and RBC, leading to lower overall blood values.