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Nierenfunktion bei Bleibelastung

Renal function and occult plumbism

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Summary

Renal failure as a consequence of manifest lead intoxication (nephropathia saturnina) has almost completely desappeared in the FRG. However, there has been rising concern that increased lead burden, primarily as a result of environmental pollution, may adversely affect blood pressure and renal function even in the absence of extrarenal signs of lead intoxication. Such concern is based on epidemiological studies which demonstrated a relation between blood lead level and blood pressure and on experimental studies which showed that lead activates several pressor mechanisms. Furthermore, increased body lead burden is found in a substantial proportion of patients with renal failure, particularly when concomitant gout is present. Unfortunately, none of the above findings constitute irrefutable evidence and further studies are clearly necessary.

Zusammenfassung

Die Schrumpfnierenbildung bei Blei-Intoxikation (Nephropathia saturnina) wird derzeit praktisch nicht mehr beobachtet. Trotzdem hat in den letzten Jahren die Besorgnis zugenommen, daß die vor allem durch umweltbedingte Faktoren gestiegene Bleibelastung langfristig zu Hochdruck und Nierenfunktionsveränderungen führen kann, selbst wenn klinisch manifeste Symptome einer Intoxikation fehlen. Diese Besorgnis stützt sich (a) auf epidemiologische Untersuchungen, in denen ein Zusammenhang zwischen Blut-Bleispiegeln und Blutdruck gefunden wurde; (b) auf experimentelle Untersuchungen, in denen Blei verschiedene pressorische Mechanismen aktivierte; (c) sowie auf den häufigen Nachweis erhöhter Bleibelastung bei Patienten mit Niereninsuffizienz, insbesondere wenn gleichzeitig eine Gicht vorliegt.

Aus verschiedenen Gründen sind die angeführten Befunde zur nephrotoxischen und Blutdrucksteigernden Wirkung bei dem gefundenen Grad der Bleibelastung nicht beweisend. Weitere Untersuchungen zur Klärung der Frage sind zweifellos von hoher gesundheitspolitischer Bedeutung.

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Literatur

  1. Lancereaux E (1881) Néphrite et arthrite saturnines; coincidence de ces affections; parallèle avec la néphrite et l'arthrite goutteuses. Arch Gén Méd (Paris) 6:641–653

    Google Scholar 

  2. Harlan WR, Landis Jr, Schmouder RL. Relationship of blood lead and blood pressure in the adolescent and adult US population. JAMA 253:530–534, 1985

    Google Scholar 

  3. Pirkle JL, Schwartz J, Landis JR, Harlan WR (1985) The relationship between blood lead levels and blood pressure and its cardiovascular risk implications. Am J Epidemiol 121:246–258

    Google Scholar 

  4. Orssaud GG, Claude JR, Moreau T, Lellouch J, Juguet B, Festy B (1985) Blood lead concentration and blood pressure. Brit Med J 290:244

    Google Scholar 

  5. Kromhout D, Wibowo AAE, Herber RFM, Dalderup LM, Heerdink H, de Lezenne Coulander C, Zielhuis RL (1985) Trace metals and coronary heart disease risk indicators in 152 elderly men (the Zutphen Study). Am J Epidemiol 122:378–385

    Google Scholar 

  6. Behringer D, Craswell P, Mohl C, Stoeppler M, Ritz E (1986) Urinary lead excretion in uremic patients. Nephron 42:323–329

    Google Scholar 

  7. Van de Vyver FL, D'Haese PC, Wisser WJ, Verpoofen GA, de Broe ME (1986) Does lead accumulation contribute to the development of endstage renal disease. 23rd Congress EDTA — European Renal Association, 29. Juni–4. Juli 1986, Budapest, a 51

  8. Colleoni N, D'Amico G (1986) Chronic lead accumulation as a possible cause of renal failure in patients with gout. Nephron (in press)

  9. Wedeen RP (1984) Poison in the Pot. The Legacy of Lead. Southern Illinois University Press, Carbondale and Edwardsville

    Google Scholar 

  10. Tronchin T (1757) De colica Pictonum. Geneva, Apud Fratres Cramer

    Google Scholar 

  11. Bright R (1836) Cases and observations, illustrative of renal disease accompanied with the secretion of albuminous urine. Guys Hosp Rep 1:338–400

    Google Scholar 

  12. Lehnert G, Szadkowski D (1983) Die Bleibelastung des Menschen. Verlag Chemie, Weinheim

    Google Scholar 

  13. Drasch GA (1982) Lead burden in prehistorical, historical and modern human bones. Sci Total Environ 24:199–231

    Google Scholar 

  14. Murozumi M, Chow TJ, Patterson C (1969) Chemical concentrations of pollutant lead aerosols, terrestrial dusts and sea salts in Greenland and Antarctic snow strata. Geochimica Cosmochimica Acta 38:1247–1294

    Google Scholar 

  15. Isotopic lead experiment — Status report 1982 EUR 8352 EN — CEC Joint Research Centre ISPRA

  16. Berlin A (1983) Biological monitoring and environmental health. Wissenschaft und Umwelt 3

  17. Rossi I (1956) La funzionalità renale nel saturnismo professionale. Rif Med 30:841–851

    Google Scholar 

  18. Crepet M, Gobbato F, Martinio P, Siracusa F (1959) La nefropatia saturnina. Minerva Nefrol 3:69

    Google Scholar 

  19. Kirkby H, Gyntelberg F (1985) Blood pressure and cardiovascular risk factors of longterm exposure to lead. Scand J Work Environ Health 11:15–19

    Google Scholar 

  20. Beevers DG, Erskine E, Robertson M, Beattie AD, Campbell BC, Goldberg A, Moore MR, Harthorne VM (1976) Blood lead and hypertension. Lancet 2:1–3

    Google Scholar 

  21. Pocock SJ, Shaper AG, Ashby D, Delves G (1985) Blood lead and blood pressure in middle aged man. Int Conf Heavy Metals in the Environment, Athens, 1:303–305

    Google Scholar 

  22. EPA accelerates ban on leaded gas. Science 227:1447–1448, 1985

    Google Scholar 

  23. Ambard L, Beaujard E (1904) Causes de l'hypertension arterielle. Arch Gén Méd N-S 1:520–523

    Google Scholar 

  24. Batuman V, Landy E, Maeseka JK, Wedeen RP (1983) Contribution of lead to hypertension with renal impairment. N Engl J Med 309:17–21

    Google Scholar 

  25. Bertel O, Bühler FR, Ott J (1978) Lead-induced hypertension: Blunted beta-adrenoreceptor mediated functions. Brit Med J 1:551–552

    Google Scholar 

  26. Webb KC, Winquist R, Victery W, Vander A (1981) In vivo and in vitro effects of lead on vascular reactivity in rats. Am J Physiol 241:H211-H216

    Google Scholar 

  27. Silbergeld EK, Goldberg AM (1975) Pharmacological and neurochemical investigations of lead-induced hyperactivity. Neuropharmacology 14:431–444

    Google Scholar 

  28. Mouw D, Vander A, Cox J, Fleischer N (1978) Acute effects of lead on renal electrolyte excretion and plasma renin activity. Toxicol Appl Pharmacol 46:435–447

    Google Scholar 

  29. Meyer-Lehnert H, Kramer HJ, Gonick HC, Lu E (1984) Hemmung der Na-K-ATP'ase durch Spurenelemente als mögliche Ursache von Bluthochdruck und Nierenkrankheiten. Verh Dtsch Ges 90:1721–1724

    Google Scholar 

  30. Ritz E, Wiecek A, Stoeppler M, Nowack R (1986) Role of lead in hypertension and renal failure. Trace Elements in Medicine 3:38–39

    Google Scholar 

  31. Lilis R, Valciukas J, Fischbein A, Andrews G, Selikoff IJ (1979) Renal function impairment in secondary lead smelter workers: correlations with zinc protoporphyrin and blood lead levels. J Environ Pathol Toxicol 2:1447–1474

    Google Scholar 

  32. Emmerson BT (1973) Chronic lead nephropathy. Kidney Int 5:1–5

    Google Scholar 

  33. Craswell PW, Price J, Boyle PD, Heazlewood VJ, Baddeley H, Lloyd HM, Thomas BJ, Thomas BW (1984) Chronic renal failure with gout: a marker of chronic lead poisoning. Kidney Int 26:319–323

    Google Scholar 

  34. Sarre H, Mertz DP (1965) Sekundäre Gicht bei Niereninsuffizienz. Klin Wschr 21:1134–1140

    Google Scholar 

  35. Batuman V, Macsaka JK, Haddad B, Tepper E, Landy E, Wedeen RP (1981) The role of lead in gout nephropathy. New Engl J Med 304:520–523

    Google Scholar 

  36. Tange JD, Hayward NJ, Brenner DA (1965) Renal lesions in experimental plumbism and their clinical implications. Australas Ann Med 14:49–56

    Google Scholar 

  37. Merke J, Wiecek A, Novak R, Mann J, Ritz E (1986) Lead affects 1,25(OH)2D3 receptor expression. 23rd Congress EDTA — European Renal Association, Budapest, June 29–July 3rd, 1985, a 5

  38. Rosen JF, Chesney RW, Hamstra A, Deluca HF, Mahaffey KR (1980) Reduction in 1,25-dihydroxyvitamin D in children with increased lead absorption. New Engl J Med 302:1128–1131

    Google Scholar 

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  1. Sektion Nephrologie, Medizinische Universitäts-Klinik, Heidelberg

    E. Ritz, A. Wiecek & J. Mann

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  1. E. Ritz
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Ritz, E., Wiecek, A. & Mann, J. Nierenfunktion bei Bleibelastung. Klin Wochenschr 64, 871–875 (1986). https://doi.org/10.1007/BF01725560

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