Adverse effects of chronic low level lead exposure on kidney function - a risk group study in children
Adverse effects of chronic low level lead exposure on kidney function - a risk group study in children
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DOI：
10.1093/ndt/13.9.2248
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发表时间：
1998-09-01
影响因子：
6.1
通讯作者：
Stolte, H
中科院分区：
文献类型：
--
作者：
Fels, LM;Wunsch, M;Stolte, H
背景儿童一直被认为是铅（Pb）毒性的风险群体，主要是因为暴露于Rb后会出现神经生理或神经认知缺陷。目前，100微克/升的血铅水平（b-Pb）已被定义为最低不良影响水平。本研究的目的是比较，在尿标记物的帮助下，肾功能的儿童与b-Pb刚刚超过这个阈值与未暴露的儿童，从肾脏学的角度来看，目前的阈值是否合理，以及儿童是否真的是一个特别脆弱的风险群体，在铅引起的肾脏损害。在一项横断面研究中，112名儿童，无论是从未暴露的地区（对照组，n = 50）或铅污染的地区（n = 62），后者部分与已知的历史升高的b-Pb，进行了检查。测定了29种主要与特定肾单位节段的功能或完整性相关的尿液或血清标志物（例如滤过的血浆蛋白、肾小管酶、肾小管抗原、类花生酸）。对照组的b-Pb为39 +/- 13 μ g/l，接触儿童为133 +/- 62 μ g/l。主要发现是暴露儿童的肾上腺素和血栓素B-2、表皮生长因子、β 2-微球蛋白和Clara细胞蛋白的排泄率增加。b-铅和患病率高于参考上限的值之间的关系observed.Conclusions，在尿标志物的帮助下，肾单位特定的儿童慢性低水平铅暴露的影响可以检测。对肾小球、近端和远端肾小管和间质标记物的影响模式与先前在成人中观察到的相似。然而，变化发生在较低的b-Pb水平比成人。从肾脏学的角度来看，目前的阈值似乎也是合理的，儿童确实可以被视为一个特殊的风险群体。
Background. Children have been considered a risk group for lead (Pb) toxicity, mainly because of neurophysiological or neuro-cognitive deficits following rb exposure. Blood Pb levels (b-Pb) of 100 mu g/l currently have been defined as the lowest adverse effect level. The aim of this study was to compare, with the help of urinary markers, the kidney function of children with b-Pb just above this threshold with that of unexposed children, to assess from a nephrological point of view whether the current threshold is justified and whether children really are a particularly vulnerable risk group in terms of Pb-induced kidney damage.Methods. In a cross-sectional study, 112 children, either from unexposed areas (controls, n = 50) or Pb-contaminated areas (n = 62), the latter partly with a known history of elevated b-Pb, were examined. Twenty nine urinary or serum markers mostly related to the function or integrity of specific nephron segments were determined (e.g. filtered plasma proteins, tubular enzymes, tubular antigens, eicosanoids).Results. b-Pb were 39 +/- 13 mu g/l in controls and 133 +/- 62 mu g/l in exposed children. The main findings were increased excretion rates of prostaglandins and thromboxane B-2, epidermal growth factor, beta(2)-microglobulin and Clara cell protein in the exposed children. A relationship between b-Pb and the prevalence of values above the upper reference limits was observed.Conclusions, With the help of urinary markers, nephron segment-specific effects of chronic low-level Pb exposure could be detected in children. The pattern of effects on glomerular, proximal and distal tubular and interstitial markers was similar to that previously observed in adults. The changes, however, occur at lower b-Pb levels than in adults. The current threshold appears to be justified also from a nephrological point of view, and children can indeed be considered a special risk group.