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Bone lead, hypertension, and lead nephropathy.

R P Wedeen1

  • 1VA Medical Center, East Orange, NJ 07019.

Environmental Health Perspectives
|June 1, 1988
PubMed
Summary

Elevated bone lead levels are a significant, often unsuspected, cause of end-stage renal disease and hypertension in dialysis patients. Noninvasive X-ray fluorescence offers a practical method for assessing bone lead burden.

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Area of Science:

  • Environmental Health
  • Nephrology
  • Toxicology

Background:

  • Excessive lead absorption is linked to renal failure and hypertension, even without overt kidney damage.
  • Elevated bone lead may contribute to end-stage renal disease (ESRD) in a notable percentage of dialysis patients.
  • Bone lead levels in affected ESRD patients are significantly higher than in controls.

Purpose of the Study:

  • To investigate the role of unsuspected elevated bone lead as a cause of ESRD and hypertension.
  • To compare bone lead levels in dialysis patients with those in unexposed individuals and lead workers.
  • To evaluate noninvasive techniques for assessing body lead burden.

Main Methods:

  • Analysis of transiliac bone biopsies to measure bone lead.
  • Comparison of bone lead levels between European dialysis patients, unexposed cadavers, and lead workers.
  • Assessment of the CaNa2 EDTA lead mobilization test as an index of body lead burden.
  • Evaluation of in vivo tibial X-ray-induced X-ray fluorescence (XRF) as a noninvasive technique.

Main Results:

  • Unsuspected elevated bone lead was identified as a cause or contributing factor in 5% of the European dialysis population.
  • Bone lead levels in these patients were four times higher than in unexposed cadavers and similar to those in lead workers.
  • The CaNa2 EDTA test is a reliable index, while in vivo tibial XRF is a practical, noninvasive alternative.

Conclusions:

  • Elevated bone lead is an important, often overlooked, contributor to renal failure and hypertension.
  • In vivo tibial XRF is a promising noninvasive tool for diagnosing lead toxicity and for epidemiological studies.
  • Measuring bone lead is crucial for understanding and managing hypertension and renal disease in at-risk populations.

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