Nephropathy in Chronic Lead Poisoning

Kim, Byoung Gwon; Kim, Sung Ryul; Hong, Young Seoub; Rha, Seo Hee; Kim, Jung Man; Jung, Kap Yull; Kim, Joon Youn

Abstract

We experienced a case of nephropathy in chronic lead poisoning. The patient was 43-year-old male who has been working in secondary lead smelting plant for ]4 years. On admission, blood pressure was 160/90 mmHg and the others were non-specific. In past history, he received chelating agent administration for lead poisoning irregularly and medicated for gout, and the blood lead concentration was 180.0 microgram/dl on 2 months before admission. Smoking habit has been 1 pack per day for 15 years and drinking habit has been 1 bottle of Soju per day but less now. In liver function test, AT/ALT were 27/28 IU/l and gamma-GT was 456 IU/l. In blood test, Hb:11. 5 g/dl , Hct: 34.0% and basophilic stipplings were found in peripheral blood smear. Chest PA was normal and abdominal ultrasonographic finding was non-specific except fatty liver. In the test of lead exposure indices, pbB: 83.0 microgram/dl, pbU: 28.3 microgram/l, and blood ZPP was 300.0 microgram/dl. And in renal function test, BUN: 31.4 mg/dl, blood creatinine: 2.7mg/dl, blood uric acid: 9.1 mg/dl, urinary albumin: 100.0 mg/g creatinine, urinary a alpha 1-microglobulin: 120.5 mg/g creatinine, urinary beta2-mioroglobulin: 183.8 microgram/g creatinine, and 24 hours urinary creatinine clearance was 31.9 ml/min. The ultasonoguided renal biopsy showed the global sclerosis of glomerulus, moderate atrophy and loss of tubule, and interstitial fibrosis in light microscopy. There were diffuse losses of brush border of proximal tubule in electronmicroscopy.