Lead nephropathy

  • Richard P. Wedeen

Occupational exposure to lead originated over 10,000 years ago in the region of the Aegean sea. The earliest description of lead poisoning is a poem dating from about 200 BC by the Greek philosopher Nikander of Colophon [1]. Although possible recognition of renal effects of lead can be traced to the 17th century, Lancereaux provided the first description of lead nephrotoxicity in modern terms in 1862. Lancereaux’s patient had saturnine (lead-induced) gout; his kidneys showed interstitial nephritis at postmortem examination [2]. Controversy concerning the renal effects of lead stems from this 19th century description compounded by the recurrent difficulty in recognizing the late sequelae of chronic absorption of relatively low levels of lead. Early reports failed to distinguish glomerular from extraglomerular renal disease. Additional confusion has been created by the failure to distinguish the transient Fanconi syndrome of acute symptomatic lead poisoning from the insidious chronic interstitial nephritis characteristic of lead nephropathy in adults.

In addition to the difficulty in assigning cause when the effect is delayed in time, identification of the renal effects of lead was further obscured because the late complications of excessive lead absorption, namely, gout and hypertension, can themselves produce renal damage unrelated to lead. The kidney has permissive control of blood pressure by modulating fluid volume and more direct control by intrarenal hormones which effect vascular tone. Hypertension and kidney disease are therefore inextricably interrelated.


Glomerular Filtration Rate Blood Lead Level Interstitial Nephritis Lead Poisoning Chelation Therapy 
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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Richard P. Wedeen
    • 1
  1. 1.Department of Veterans Affairs New Jersey Health Care SystemEast OrangeUSA

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