Original scientific paper
Clinical observations on the effect of lead on the kidney
Z. Radošević
; Interna klinika Medicinskog fakulteta i Institut za medicinska istraživanja u Zagrebu
M. Šarić
; Interna klinika Medicinskog fakulteta i Institut za medicinska istraživanja u Zagrebu
Jelica Knežević
; Interna klinika Medicinskog fakulteta i Institut za medicinska istraživanja u Zagrebu
T. Beritić
; Interna klinika Medicinskog fakulteta i Institut za medicinska istraživanja u Zagrebu
Abstract
The problem of the toxic effect of lead upon the kidney, in spite of numerous studies, has not as yet been fully solved. The report presented deals with the clinical observations of 54 lead poisoned patients. Lasting kidney changes in the form of chronic, progredient and diffuse nephropathy were observed in only 2 patients with an exposure to high lead concentrations during a period of 20 and 35 years respectively, and repeated lead poisonings. These two patients had no history of previous kidney disorders, and kidney injuries progressed with repealed lead poisonings. It may, therefore, be assumed that the lesions observed were due to lead action. 24 patients showed functional kidney alterations which were proved by the test of urine concentration, the phenolsulphthalein test, the urea clearance test, and the urea value in the blood. Urine showed no abnormality in these cases. In the authors' opinion these functional changes mostly consist in altered intrarenal circulation due to the spastic effect of lead upon the blood vessels of the kidney and the direct toxic and indirect hypoxic effect of lead upon the tubules. The injuries of partial renal functions were as a rule reversible. In only 6 patients the blood pressure was increased. 2 patients with hypertension were those with progredient organic nephropaty. It seems most probable that in these two cases hypertension was nephrogenic in character. In one case high blood pressure was of the type of essential hypertension, but the relation between lead poisoning and hypertension in this case cannot be assumed with certainty. In other 3 patients hypertension was transitory in type, lasting only during the acute manifestations of lead poisoning. Functional kidney alterations tend to change according to the natural course of the disease. This is why it is not the same in which phase of the poisoning functional kidney tests are carried out. If this fact is neglected, divergent and contradictory results may be obtained. On the basis of these clinical findings the authors conclude that lead exposure and lead poisoning may cause kidney injuries. However, these changes are not uniform and cannot therefore be considered a clinical and nosologic entity usually called nephropathia saturnina. In the exceptional cases of a very long and high exposure to lead and repeated poisoning, progressive organic kidney changes may be expected. Otherwise, possible renal alterations and changes in the blood pressure are functional and reversible.
Keywords
Hrčak ID:
183487
URI
Publication date:
25.9.1958.
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