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Biomedical subjects

C D Hong

Publications and source records attributed to C D Hong.

At least 19 recordsLinked to original sources
PubMed2001

Effects of fixed low-dose warfarin on hemostatic factors in continuous ambulatory peritoneal dialysis patients.

Increased coagulation factors found in dialysis patients may explain in part the high prevalence of thrombotic cardiovascular disease. Several studies showed low-dose warfarin is effective in decreasing coagulation factors and preventing thrombosis without increasing the risk of bleeding. To evaluate the effects of fixed low-dose warfarin therapy on thrombogenesis in continuous ambulatory peritoneal dialysis (CAPD) patients, 76 CAPD patients were assigned randomly to treatment and disease control groups. The treatment group received 2 mg of warfarin daily for 12 months. International normalized ratio (INR) of the prothrombin time and plasma levels of factor VII, D-dimer, von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1) were measured before and 3, 6, and 12 months after the start of medication. The same parameters were measured in 30 healthy volunteers at the beginning of the study and in the disease control group during the study period. Of 76 patients, 60 completed the study. Deaths from atherosclerotic cardiovascular disease (cerebral infarction or acute myocardial infarction) occurred in 1 patient in the treatment group (n = 29) and 3 in the disease control group (n = 31), which was not statistically significant. No major bleeding occurred during the study period. With administration of warfarin, there was a small increase in INR in the treatment group. CAPD patients at baseline had significantly higher plasma factor VII, D-dimer, vWF, and PAI-1 levels than normal controls. Warfarin therapy lowered plasma factor VII and D-dimer levels. No change was seen in vWF and PAI-1 levels. In the disease control group, these hemostatic factors showed no change during the study period. There was a negative correlation between serum albumin and INR in the treatment group during the study period. Fixed low-dose warfarin was effective in partially reversing the thrombogenic coagulation profile in CAPD patients without a big increase in the risk of bleeding.

Anticoagulants↗
PubMed2001

Complementary and alternative medicine in Korea: current status and future prospects.

Traditional Oriental medicine has been an integral part of prevailing practice and belief systems throughout Korea's history. Beginning late in the nineteenth century, Western medical practices were introduced by Christian missionaries and these practices quickly supplanted traditional medicine in institutional health care. After the Korean War, the government revived interest in Oriental medicine and established colleges of Oriental medicine, in addition to supporting the colleges of Western medicine. A difference in standards between these medical traditions underlies a mistrust of complementary and alternative medicine (CAM) that is common among practitioners of Western medicine. Western medicine is built on reproducible experiments and statistical analysis, whereas complementary and alternative treatments are built on experience. Recent surveys show that CAM is widely used in Korea, with usage rates ranging from 29% to 53% among various patient populations. CAM also accounts for a large share of healthcare costs. Approximately 29% of out-of-pocket, health care expenditure in Korea is for CAM therapies. Both the Korean government and the medical community recognize a need to integrate the health care delivery system and to define the roles of physicians, Oriental medical doctors, and pharmacists better. To accomplish this, there will be a need for standards for judging the safety and effectiveness of treatments and consensus-building will be needed to overcome the differences among practitioners from various traditions and backgrounds.

Attitude of Health Personnel↗
PubMed1999

Effect of increasing serum albumin on plasma D-dimer, von Willebrand factor, and platelet aggregation in CAPD patients.

This study was performed to investigate the interrelation between blood albumin level and D-dimer (a marker of intravascular coagulation) and von Willebrand factor (vWF; a marker of endothelial injury) levels or platelet aggregation. Blood levels of albumin, D-dimer, vWF, and C-reactive protein (CRP) and the threshold aggregating concentration (TAC) of ristocetin were measured in 64 continuous ambulatory peritoneal dialysis (CAPD) patients and compared with 36 healthy controls. Twenty-two CAPD patients with albumin levels less than 3.0 g/dL were divided into experimental and disease-control groups. In the experimental group, levels were measured before and after repeated infusions of 20% albumin, 100 mL/d for 7 days. The same parameters were measured in the disease-control group that did not receive the albumin infusion. CAPD patients had higher D-dimer and vWF levels than the healthy controls. There were inverse correlations between albumin and D-dimer (r = -0.48; P < 0.001), vWF (r = -0.29; P < 0.05), or logCRP (r = -0.44; P < 0.001) in CAPD patients. There were positive correlations between logCRP and D-dimer (r = 0.38; P < 0.01) and between logCRP and vWF (r = 0.32; P = 0.01) in CAPD patients. No change was seen in D-dimer, vWF, and CRP levels in either group. The TAC of ristocetin in the 18 CAPD patients was not different from that in the 11 healthy controls (0.55 +/- 0.09 v 0.65 +/- 0.07 mg/mL). There was a correlation between albumin level and TAC in the CAPD patients (r = 0.59; P < 0.01). TAC increased from 0.50 +/- 0.09 to 0.62 +/- 0.13 mg/mL (123% +/- 17%; P < 0.05; n = 6) at the end of the repeated albumin infusions in the experimental group, whereas it did not change in the control group. CRP level did not change in either group. The results of this study indicate that hypoalbuminemia increases platelet aggregability. The observation that the albumin infusion was not associated with changes in D-dimer and vWF despite the inverse correlations suggests that these relationships may be secondary to other factors, such as inflammation.

Adult↗
PubMed1997

Protein intake and the nutritional status in patients with pre-dialysis chronic renal failure on unrestricted diet.

OBJECTIVES: Malnutrition is known to be highly associated with morbidity and mortality in dialysis patients. Malnutrition may begin to develop in patients with chronic renal failure(CRF) before they need dialysis. In this study, the nutritional status of patients with moderate to severe CRF on unrestricted diet was evaluated. METHODS: We measured dietary protein intake (DPI, g/kg/day) in 64 patients with CRF and 42 normal controls(N). Nutritional indices such as serum albumin(SA, g/dl), transferrin(TF, mg/dl), prealbumin(PA, mg/dl) and insulin-like growth factor-1(IGF-1, ng/ml) were measured to evaluate the visceral proteins, and creatinine-height index(C-H, g/d/m) to evaluate the somatic proteins. RESULTS: Mean DPI was 0.80 +/- 0.27(S.D) in CRF and 1.07 +/- 0.30 in N(p < 0.0001). DPI was lower than 0.6 in 15 CRF patients(23%). Serum albumin, transferrin and C-H were significantly lower in CRF patients than in N(p < 0.01). In patients with CRF, nutritional indices were significantly worse with lower DPI(< 0.6 g/kg/d, n = 15) than higher DPI(> 0.6 g/kg/d, n = 49)(SA 2.9 +/- 0.7 vs. 3.6 +/- 0.8, p < 0.005; TF 147 (134-179) vs. 220(182-264), p < 0.0005; PA 24 +/- 8 vs. 32 +/- 9, p < 0.001; IGF-1 123 (66-261) vs. 226(140-344), p < 0.05; C-H 0.52 +/- 0.15 vs. 0.87 +/- 0.23, p < 0.0001). CRF patients with nephrotic range proteinuria (> 3.5 g/d, n = 19) had lower SA (2.8 +/- 0.6 vs. 3.8 +/- 0.8, p < 0.0001) and PA(27 +/- 9 vs. 32 +/- 9, p < 0.05). CRF patients with diabetes mellitus (n = 20) showed worse nutrition than non-diabetic patients(SA 2.8 +/- 0.6 g/dl vs. 3.8 +/- 0.8 g/dl, p < 0.0001; TF 176 mg/dl(148-214) vs. 220 mg/dl(175-266), p < 0.05; PA 24 +/- 10 mg/dl vs. 33 +/- 8 mg/dl, p < 0.0005; IGF-1 138 ng/ml(69-269) vs 231 ng/ml(140-364), p < 0.05; C-H 0.66 +/- 0.23 vs. 0.85 +/- 0.5, p < 0.005). CONCLUSION: A significant protein malnutrition prevails in patients with pre-dialysis CRF on unrestricted diet, especially with low protein intake. The effort to detect and correct malnutrition should be made in patients with CRF even before initiation of maintenance dialysis.

Adult↗
PubMed1996

Inhibition of renin secretion by Ca2+ through activation of myosin light chain kinase.

This study sought to identify specific enzyme(s) involved in the biochemical cascade of inhibition of renin secretion through Ca(2+)-calmodulin mediation with the use of inhibitors of protein kinase and phosphatases. Inhibition of renin secretion mediated by Ca(2+)-calmodulin was induced by incubating rat renal cortical slices in K(+)-rich depolarizing medium, producing > 50% inhibition. This inhibition was completely blocked by the calmodulin antagonist calmidazolium. The inhibitor of protein kinase with broad specificity, K-252a, blocked the inhibition of renin secretion. Neither KN-62, a specific inhibitor of Ca(2+)-calmodulin-dependent protein kinase II (CaMK II), nor specific inhibitors of protein phosphatase 2B (PP2B), cyclosporin A and FK-506, blocked the inhibition. On the other hand, all four known inhibitors specific for myosin light chain kinase (MLCK), with different chemical structures and mechanisms of inhibition (ML-9, ML-7, KT-5926 and wortmannin), almost completely protected renin secretion against the inhibition by Ca2+. In particular, ML-9 reversively protected > 77% secretion against the inhibition both in K(+)-rich medium alone and in combination with the calcium ionophore A-23187 in a concentration-dependent manner. Together, these findings from our present study provide the first evidence, albeit indirect in nature, for the possibility that activation of Ca(2+)-calmodulin-dependent MLCK at the downstream of Ca2+ influx into juxtaglomerular (JG) cells leads to phosphorylation of 20-kDa regulatory myosin light chain (MLC20). Through interaction with actin, the phosphorylated MLC20 may play an important role in the inhibitory stimulus-secretion coupling of renin.

Animals↗
PubMed1996

Inhibitory effect of Ca2+ on renin secretion elicited by chemiosmotic stimuli through actomyosin mediation.

We had previously shown that several experimental manipulations, which are likely to produce osmotic swelling of renin secretory granules, stimulate secretion of renin (C.S. Park, T.W. Honeyman, S. K. Ha, H. K. Choi, C. L. Chung, and C. D. Hong. J. Pharmacol. Exp. Ther. 259: 211-218, 1991). In subsequent studies, Ca2+ was found to block the stimulation of renin secretion evoked by osmotic swelling of renin secretion granules [Park, Hong, and Honeyman, Am. J. Physiol. 262 (Renal Fluid Electrolyte Physiol. 31): F793-F798, 1992]. Furthermore, evidence from our recent studies indicates that myosin light chain kinase (MLCK) might be involved in the inhibition of renin secretion through Ca(2+)-calmodulin. In the present study we investigate the possibility that MLCK might mediate the inhibitory action of Ca2+ on renin secretion stimulated by osmotic swelling of renin secretory granules. Rat renal cortical slices were incubated under a variety of experimental conditions that would produce osmotic swelling of renin secretory granules. Incubation in hypotonic KCl medium, isosmotic NH4Cl or CH3COONH4 medium, or isosmotic KCl or CH3COOK medium plus nigericin in the absence of Ca2+ all produced a significant increase in renin secretion 2- to 14-fold (P < 0.001). Ca2+ added to all of these media partially or completely blocked the stimulatory effects (P < 0.001). This inhibitory effect of Ca2+ was significantly blocked by ML-9 (10(-4) M, P < 0.001), a putative specific inhibitor of the Ca(2+)-calmodulin-dependent MLCK. Taken together, the present findings support the idea that the renin secretory response may involve chemiosmotic swelling of renin secretory granules. This pivotal step may be regulated by contractile actomyosin interaction, which is in turn modulated through the Ca(2+)-calmodulin-dependent activity of MLCK.

Acetates↗
PubMed1996

Effects of hypoxia on the extracellular matrix production of cultured rat mesangial cells.

Glomerular changes in patients with cyanotic congenital heart and chronic lung diseases and in persons living at a high altitude might be related to hypoxemia. This study was carried out to examine the effects of hypoxia on the extracellular matrix production by cultured rat mesangial cells (CRMC). Subconfluent CRMC monolayers were grown with 10% oxygen (hypoxia) and 20% oxygen (control) for 1, 3, and 5 days. The production of type IV collagen (CIV), fibronectin (FN), and laminin (LN) by CRMC was evaluated by flow cytometry and immunofluorescent microscopy. Total RNA was extracted and Northern blotting and hybridization were performed with cDNAs for CIV, FN, and LN. The surface expression of CIV on FC was higher in hypoxia than under control conditions at day 5 (158% of control). The surface expression of FN was also higher in hypoxia at day 3 (303%) and at day 5 (332%). The surface expression of LN was lower at day 1 (71%). Immunofluorescent microscopy showed similar changes with flow cytometry. The mRNA level for CIV and FN was maximal at day 5 with 206 and 305% of control, respectively. Hypoxia had little effect on LN mRNA expression. These results show that hypoxia stimulates the synthesis of extracellular matrix of cultured rat mesangial cells. Hypoxia may contribute to the development of glomerular changes in cyanotic congenital heart diseases, chronic lung diseases, and in persons living at a high altitude.

Animals↗
PubMed1994

Clinical value of DMSA planar and single photon emission computed tomography as an initial diagnostic tool in adult women with recurrent acute pyelonephritis.

Routine DMSA scintigraphy, ultrasound (US) of the kidney, intravenous pyelography (IVP) and voiding cystoureterography (VCU) were performed in 27 consecutive adult women with recurrent acute pyelonephritis (APN) during a 12-month follow-up. Both planar and single photon emission computed tomography (SPECT) images were obtained for DMSA scan. DMSA scans were repeated in those patients with abnormal initial scan. DMSA-SPECT showed normal findings in 2, single renal cortical detect (RCD) in 9 and multiple RCD in 16 (including nonvisualization in 2). Of the 11 kidneys with normal findings or single RCD on DMSA-SPECT, only 1 (9%) showed vesicoureteral reflux (VUR) on VCU (grade I). A large proportion of those with multiple RCDs showed abnormal findings on IVP (44%, 7/16), US (38%, 6/16) or VCU (31%, 5/16); 63% in any of these three studies. 5 of 6 patients with VUR had multiple RCDs on DMSA-SPECT, and 3 of these 5 showed no abnormality on IVP or US. 7 patients who needed other managements besides initial standard antibiotic treatment had multiple RCDs on DMSA-SPECT. 15 normal women were also studied and showed normal DMSA-SPECT, US and IVP, in all cases. Follow-up DMSA-SPECT was done in 16 patients (7 with single RCD, 9 with multiple RCD). All 7 patients with single RCD showed improvement, in those with multiple RCDs improvement was observed in 2, no change in 7 on follow-up studies. We conclude: (1) DMSA-SPECT is a useful initial diagnostic tool in adult women with recurrent APN to identify patients who need more extensive radiological studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Effects of low density lipoprotein on type IV collagen production by cultured rat mesangial cells.

Hyperlipidemia, especially hypercholesterolemia, may contribute to glomerulosclerosis as it does to atherosclerosis. Low density lipoprotein (LDL) stimulates the production of extracellular matrix by mesangial cells in culture as well as the proliferation of mesangial cells. This study was carried out to examine the effects of LDL on the type IV collagen (CIV) production by cultured rat mesangial cells (CRMC). Subconfluent CRMC monolayers which were grown in RPMI with 20% lipid-free fetal calf serum for 48 h were challenged with LDL (0, 50, 100, 150 and 200 micrograms/ml) for another 48 h. LDL was prepared from normal human plasma. Mesangial cell proliferation was examined by [3H]-thymidine uptake. Production of CIV was evaluated as the expression of CIV on the cell surface by flow-cytometric analysis. The collagen synthesis was measured by the [3H]-proline uptake. Total RNA was extracted from CRMC at 6 and 24 h of incubation with 150 micrograms/ml LDL, and Northern blotting and hybridization was performed with cDNAs for alpha 1-CIV, for 72-kD collagenase and for tissue inhibitor of metalloproteinase (TIMP)-2. The amount of total mRNA was corrected with beta-actin mRNA. Mesangial cell proliferation increased in all concentrations studied and had a peak value of 221% with 150 micrograms/ml of LDL. Expression of CIV increased by 30-60% in 100-200 micrograms/ml of LDL. Collagen synthesis also increased by 50-70% in 150-200 micrograms/ml of LDL. The mRNA ratio (procollagen alpha 1(IV)/beta-actin) increased to 133% at 24 h. The mRNA ratio (TIMP-2/beta-actin) increased to 137% at 24 h. mRNA ratios at 6 h showed no change.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Cytomegalovirus is not specifically associated with immunoglobulin A nephropathy.

Cytomegalovirus (CMV) has been suspected to be involved in the pathogenesis of IgA nephropathy (IgAN). Whether CMV is present in renal tissue of IgAN, however, remains controversial. To determine the presence of CMV in IgAN, compared with other glomerulonephritis (GN) as disease control, polymerase chain reaction amplifying a 159-base-pair fragment of the immediate early gene of CMV and indirect immunofluorescence staining with anti-CMV monoclonal antibody were performed on 10 IgAN and 14 non-IgAN GN renal tissues. CMV DNA was detected in 6 of 10 IgAN tissues and 10 of 14 other GN by polymerase chain reaction, whereas no CMV antigen was detected in all renal tissues by immunofluorescence. This frequent observation of CMV DNA in various types of GN as well as in IgAN would suggest that CMV is not specifically associated with the pathogenesis of IgAN seen in endemic areas of CMV infection.

Antigens, Viral↗
PubMed1993

Effect of recombinant human erythropoietin on muscle energy metabolism in patients with end-stage renal disease: a 31P-nuclear magnetic resonance spectroscopic study.

To evaluate the effects of recombinant human erythropoietin (r-HuEPO) on muscle energy metabolism in patients with end-stage renal disease (ESRD), 10 patients receiving maintenance hemodialysis were given r-HuEPO (3,000 U three times a week for 8 weeks). Intracellular phosphocreatine to inorganic phosphate ratios and pH were measured with 31P-nuclear magnetic resonance spectroscopy before and after all-out handgrip exercise, before treatment and at 4 and 8 weeks after r-HuEPO treatment. The same measurements, from 14 normal individuals also were studied for comparison. The hematocrit increased significantly with r-HuEPO treatment, although the dose of r-HuEPO did not correct it to the normal level. The exercise capacity improved significantly. Intracellular pH was not different between the ESRD patients and controls or between before and after r-HuEPO treatment. The phosphocreatine to inorganic phosphate ratio at the resting state improved significantly with r-HuEPO treatment, reaching the same level as the normal subjects even before the low hematocrit normalized. The measurements immediately after exercise were the lowest levels obtained (the nadir state) and were not different between groups. In the state of maximum recovery, a pattern was noted that was similar to that found in the resting state. These results showed that r-HuEPO treatment improved the phosphorylation potential during the resting state and the maximum phosphorylation potential during the postexercise recovery phase, and suggest that the treatment improved the rate of oxidative phosphorylation in ESRD patients receiving hemodialysis.

Adult↗
PubMed1992

Calcium-dependent inhibitory step in control of renin secretion.

The regulatory step for Ca(2+)- and calmodulin-dependent control of renin secretion was studied in rabbit renal cortical slices. Renin secretion was stimulated by adding the K(+)-H+ exchange ionophore nigericin or a weak base, benzylamine, to Ca(2+)-free incubation medium. Both nigericin and benzylamine can produce chemiosmotic swelling of acidic intracellular organelles in a pH gradient-dependent manner. Swelling of renin secretory granules may account for the stimulatory effects of these two agents on renin secretion. The stimulation of renin secretion by each of these agents was prevented by including Ca2+ in the incubation medium. The inhibitory effects of Ca2+ were reversed by the calmodulin antagonist calmidazolium, suggesting that the Ca2+ inhibition may be mediated by calmodulin. However, when renin secretion was first stimulated by nigericin or benzylamine in Ca(2+)-free medium, subsequent addition of Ca2+ to the incubation medium failed to reverse the stimulation. These results therefore suggest that Ca2+ acting through calmodulin may exert its inhibitory effects on renin secretion by blocking an early step in the cellular events that lead to renin secretion such as pH gradient-dependent swelling of renin secretory granule.

Animals↗
PubMed1991

Mechanisms of ionophore-induced stimulation of renin secretion with special reference to a chemiosmotic hypothesis.

The effects of several ionophores on renin secretion were investigated in rabbit renal cortical slices. When slices were incubated in the absence of Ca++, the K+ ionophore valinomycin (10(-5) approximately 5 x 10(-4) M) or the monovalent cation ionophore nonactin (10(-4) M) stimulated renin secretion about 2-fold. The renin secretion stimulated by valinomycin was further increased by inclusion of the H+ ionophore, carbonylcyanide m-chlorophenylhydrazone. The electroneutral K+/H+ exchange ionophore nigericin (10(-5) approximately 5 x 10(-4) M) stimulated renin secretion in a dose-dependent manner, producing a maximal stimulation of about 17-fold. Another electroneutral exchange ionophore, monensin, also significantly stimulated secretion. The stimulation by both valinomycin and nigericin was apparent whether slices were incubated in Na(+)-rich or K(+)-rich media. The extent of stimulation by the two ionophores was dependent upon the presence of anion with acetate greater than Cl greater than isethionate greater than thiocyanate. Thiocyanate itself markedly inhibited renin secretion. Incubating of slices in an iso-osmotic ammonium acetate medium which is known to induce rapid swelling of secretory granules, stimulated renin secretion to the magnitude comparable to that of maximal stimulation by nigericin in a potassium acetate medium. The pattern of response to these ionophores indicates that changes in K+, H+ and anion gradients across the renin secretory granule may modulate renin secretory rate. It is proposed that conditions which allow accumulation of K+ and anion within acidic renin secretory granules lead to osmotic swelling of the granules and that granule swelling may promote exocytosis.

Animals↗
PubMed1990

Anthropometric norms for the dialysis population.

Although norms are available for healthy subjects, it is preferable, when interpreting anthropometry in individual dialysis patients, to compare measurements with norms for the stable dialysis population. The purpose of this study was to develop these reference anthropometric norms for dialysis patients. Triceps skinfold (TSF), subscapular skinfold (SSF), and mid-upper arm circumference (MUAC) measurements were made in 925 patients with no major illness, who were being treated by chronic maintenance dialysis in 27 dialysis facilities. Of these, 609 patients treated by hemodialysis (HD) were in subgroups large enough to compare with those from the National Health and Nutrition Examination Survey (NHANES) II. Diabetic patients were significantly different from nondiabetic patients; therefore, the two groups were analyzed separately. Male HD patients (diabetic and nondiabetic) did not differ significantly from the NHANES II data. Diabetic HD females did not differ significantly from the NHANES II data, except for the TSF of black women older than 55 years. Measurements of nondiabetic HD females (black and white) were significantly below the NHANES II data. In 138 continuous ambulatory peritoneal dialysis (CAPD) patients, measurements were similar to those of HD patients.

Adolescent↗
PubMed1986

Comparison of buffering capacity in patients on hemodialysis and continuous ambulatory peritoneal dialysis.

A standard acid loading test was used to assess the buffering capacity in 9 hemodialysis (HD) and 25 continuous ambulatory peritoneal dialysis (CAPD) patients. There was a significant increase in H+ concentration and a decrease in plasma bicarbonate levels after the acid loading in all patients; however, PaCO2 did not change significantly. CAPD patients tolerated the acid load better, at least in the first 2 h, than HD patients. The brief duration of experiments did not allow us to observe differences, if any, in the recovery rates between HD and CAPD patients. CAPD patients tolerated the acid load equally, whether studied with or without fresh dialysate in the peritoneal cavity. Their tolerance to the acid load did not change with an increasing duration of the CAPD therapy. Baseline values and acid tolerance curves were similar in CAPD patients on regular Dianeal (lactate 35 mEq/l) and Dianeal PD2 (lactate 40 mEq/l). It is concluded that the buffering capacity is marginally higher in CAPD than in HD patients, although the baseline acid-base parameters were essentially identical.

Acid-Base Imbalance↗
PubMed1980

Renal parenchymal malakoplakia. A case associated with renal vein thrombosis and partial recovery of kidney function.

A 65-year-old woman with bilateral renal parenchymal malakoplakia and renal vein thrombosis had severe azotemia, bilaterally enlarged kidneys, urinary tract infection, and sepsis. Angiographic studies demonstrated left renal vein thrombosis. A percutaneous kidney biopsy specimen showed the characteristic Michaelis-Gutmann bodies. After therapy with fluid replacement, antibiotics, and long-term anticoagulation, kidney function improved and both kidneys decreased in size. We suggest that, with adequate treatment of urinary tract infection and correction of potential insults to the kidney, progression of this peculiar disease can be prevented.

Aged↗
PubMed1980

Occupational exposure to lead: effects on renal function.

Although nephrotoxicity is common following exposure to lead, the dose-response relationship in adults with occupational exposure is not well understood because information is lacking on early nephrotoxic effects. By the time serum urea nitrogen and creatinine levels are elevated, renal damage may be advanced and not fully reversible. Detailed investigations of renal glomerular and tubular function were performed in six adults with occupational exposure to lead. In all patients, the serum creatinine and urea nitrogen concentrations were within the normal range. GFR was decreased in all but two. Glucose reabsorptive capacity (TmG) was decreased in all, and this decrease was disproportionately greater than expected from the reduced GFR in all but one. Normal values for renal plasma flow (RFP) were observed in four of the six, and for rho-aminohippurate (PAH) secretory capacity (TmPAh) in all but one. Bicarbonate reabsorptive capacity (TmHCO3) and urinary excretion of beta2-microglobulin were normal in all. Routine clinical laboratory tests are insensitive for the detection of early renal effects of heavy metal exposure. Measurements of renal tubular reabsorptive capacity for glucose appears to be a sensitive method for the early detection of renal effect of lead.

Adult↗