Chronic renal failure from lead: myth or evidence-based fact?

作者：Evans Marie^*; Elinder Carl Gustaf

来源：Kidney International, 2011, 79(3): 272-279.

DOI：10.1038/ki.2010.394

• chronic renal failure
• clinical nephrology
• epidemiology and outcomes
• nephrotoxicity

In this mini review, we would like to challenge the well-established 'fact' that lead exposure causes chronic renal failure (CRF). Even though only scarce evidence exists of the relationship between lead and renal failure, a World Health Organization Environmental Health Criteria document summarizes that 'Lead has been a very common cause of acute or chronic renal failure'. It is also written and cited in textbooks and numerous publications that chronic lead nephropathy causes a slowly progressive interstitial nephritis manifested by a reduced glomerular filtration rate, and that there is a growing consensus that lead contributes to hypertension in the general population. We will argue that, when published reports are carefully scrutinized, such statements on lead and CRF are not evidence based but are rather founded on a few narrative reports on lead-exposed individuals and statistical associations between lead and serum creatinine (or urea) in a few population studies. We will, however, not argue that lead is not toxic and that lead does not cause other types of severe health effects where the evidence is unquestionable, but we do not believe that the kidneys are an early victim after lead exposure. Kidney International (2011) 79, 272-279; doi:10.1038/ki.2010.394; published online 13 October 2010

• 出版日期2011-2