The role of lead in renal failure

The CaNa2EDTA lead mobilization test permits identification of lead nephropathy in a variety of situations in which past-exposure is uncertain and acute symptoms of lead poisoning are lacking. In addition to lead workers and moonshiners, lead nephropathy has been identified in gout patients with renal failure and in hypertensives with renal failure. The presence of excessive mobilizable lead in these patients and its absence in control patients with comparable renal dysfunction suggests that unrecognized lead poisoning is sometimes responsible for renal failure in gout and hypertension. Use of the EDTA lead-mobilization test may thus permit prevention and sometimes treatment of renal failure in patients who might otherwise enter the End-Stage Renal-Disease Program. The controversies surrounding interstitial nephritis in lead poisoning, gout and hypertension may in part be explained by the surreptitious role of lead.