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Renal function and hyperfiltration capacity in lead smelter workers with high bone lead
H Roels1, R Lauwerys, J Konings
1Unit of Industrial Toxicology and Occupational Medicine, Medical School, Catholic University of Louvain, Brussels, Belgium.
Occupational and Environmental Medicine
|August 1, 1994
Summary
Lead-exposed workers with altered eicosanoid excretion showed normal renal hemodynamic responses to a protein load. Moderate lead exposure may even be linked to a hyperfiltration state, suggesting unlikely adverse renal changes in most male workers below specific blood lead levels.
Area of Science:
- Environmental Health
- Nephrology
- Occupational Medicine
Background:
- Previous studies indicated altered urinary eicosanoid excretion (decreased 6-keto-PGF1 alpha and PGF2, increased thromboxane) in lead (Pb) exposed workers.
- These eicosanoid changes were hypothesized to potentially impair renal hemodynamic response to acute oral protein load.
Purpose of the Study:
- To assess if previously observed changes in urinary eicosanoid excretion in lead-exposed workers affect their renal hemodynamic response to an acute oral protein load.
- To evaluate the impact of chronic lead exposure on renal function markers and the kidney's capacity to increase glomerular filtration rate after protein intake.
Main Methods:
- Cross-sectional study involving 76 male lead workers and 68 age/sex-matched controls.
- Renal hemodynamic response assessed by creatinine clearance increase after a 400g cooked red meat meal.
- Lead exposure quantified via in vivo tibial lead concentration (Pb-T), blood lead (Pb-B), and urinary lead (Pb-U).
Main Results:
- Lead workers exhibited significantly higher Pb-T, Pb-B, and Pb-U compared to controls.
- No significant changes in standard nephrotoxicity markers (urinary proteins, enzyme activities, serum markers) were observed in lead workers.
- Both groups showed a similar significant increase (approx. 15%) in creatinine clearance after protein load, indicating no adverse effect on renal hemodynamics due to eicosanoid changes.
Conclusions:
- Lead-exposed workers displayed normal, even slightly elevated, baseline and stimulated creatinine clearance rates, positively correlated with tibial lead burden.
- Moderate lead exposure might be associated with a mild hyperfiltration state, potentially counteracting age-related decline in kidney function.
- Adverse renal changes are unlikely in adult male workers with blood lead levels below 700 µg/l, though caution is advised for general population extrapolation due to pre-employment screening.