Renal hazards from cadmium, mercury and other pollutants
by Carl-Gustaf Elinder
Introduction
01 Cancer
02 Ozone
03 Urban air
04 Air pollutants
05 Blue-green algae
06 Water mutagens
07 Contamination
08 Chernobyl
09 Radon
10 Medical geology
11 Renal hazards
12 Organohalogens
13 Estrogens
14 Food hazards
15 Mycotoxins
16 Poisoning
17 Genetics
18 Risk
(Excerpt from Chapter 11)
Cumulative incidence of renal stones in relation to the cumulative inhalative exposure to cadmium among cadmium-battery workers in Sweden (from Järup and Elinder, 1993). The risk of experiencing renal stone increases with the cumulative inhalative dose of cadmium. |
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Renal Disease
The kidneys have a central, albeit unobtrusive, role in human health. Life is not possible without renal function. In the case of chronic and total renal failure, renal replacement therapy (RRT) in the form of dialysis and kidney transplantation is necessary. The prevalence of RRT is steadily increasing all over the world, in most countries at an annual rate of about 5%. In western Europe, Japan and the US the prevalence of RRT varies between 300 and 1000 per million. The main reason for the continuing growth in RRT is increased survival thanks to the treatment. Before dialysis and kidney transplantation became possible all patients with end-stage renal disease died. But there is also the fact that more and more patients are treatable and are accepted for treatment. The peak prevalence for dialysis treatment in Sweden, for example, is in the age group 70 - 75.
However, renal replacement therapy is very expensive for society and/or the insurance system, and complicated and tedious for the patient. The annual cost of hemo-dialysis, for example, is on the order of $ 50,000. Prevention of renal disease and failure is therefore very important.
Our knowledge about causes of renal diseases is limited. Diabetes, arteriosclerosis and various types of auto-immune and hereditary diseases are important causes, but in many cases the etiology remains unknown. Certain drugs and chemicals, such as phenacetine and ethylene glycol, are well known as being able to elicit acute and chronic failure. There are also a number of chemicals and metals that may exert more insidious nephrotoxic effects (Table 1) and several of these will be discussed in this chapter. A good review of toxic nephropathies has been provided by WHO (1991) and by De Broe et al (1998).
The normal kidney function and early diagnosis of damage from toxic substances
The kidneys play an essential part in the regulation of the fluid and electrolyte balance in the body and in controlling the blood pressure. A number of several potentially toxic substances, both exogenous (entering the body from the outside) and endogenous (produced in the body), are eliminated effectively via the kidneys. The capacity of the kidneys to purify the blood is considerable. In the adult the filtration of blood through millions of glomeruli results in the production of approximately 125 ml of so called primary urine every minute, which corresponds to a production of 180 l/day.
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Carl-Gustaf Elinder is Consultant in Nephrology at the Department of Renal Medicine, Huddinge University Hospital in Stockholm. Dr. Elinder has been an active researcher in the field of environmental health and medicine for twenty years and has published more than 100 scientific and overview papers, many of them dealing with health effects, and in particular renal ones, from exposure to metals. Together with Drs. Lars Friberg and Tord Kjellström he prepared the first draft of the WHO environmental health criteria document on cadmium and took part in the Task Group meetings. Dr. Elinder is a member of the Scientific Advisory Board for the Registry of the European Dialysis and Transplantation Association (EDTA).
