title: Tubular and glomerular kidney effects in Swedish women with low environmental cadmium exposure.
abstract: Cadmium is a well-known nephrotoxic agent in food and tobacco, but the exposure level that is critical for kidney effects in the general population is not defined. Within a population-based women's health survey in southern Sweden (Women's Health in the Lund Area, WHILA), we investigated cadmium exposure in relation to tubular and glomerular function, from 1999 through early 2000 in 820 women (71% participation rate) 53-64 years of age. Multiple linear regression showed cadmium in blood (median, 0.38 microg/L) and urine (0.52 microg/L; density adjusted = 0.67 microg/g creatinine) to be significantly associated with effects on renal tubules (as indicated by increased levels of human complex-forming protein and N-acetyl-beta-D-glucosaminidase in urine), after adjusting for age, body mass index, blood lead, diabetes, hypertension, and regular use of nephrotoxic drugs. The associations remained significant even at the low exposure in women who had never smoked. We also found associations with markers of glomerular effects: glomerular filtration rate and creatinine clearance. Significant effects were seen already at a mean urinary cadmium level of 0.6 microg/L (0.8 microg/g creatinine). Cadmium potentiated diabetes-induced effects on kidney. In conclusion, tubular renal effects occurred at lower cadmium levels than previously demonstrated, and more important, glomerular effects were also observed. Although the effects were small, they may represent early signs of adverse effects, affecting large segments of the population. Subjects with diabetes seem to be at increased risk.
authors.affiliation: Institute of Environmental Medicine, Division of Metals and Health, Karolinska Institutet, Stockholm, Sweden. Agneta.Akesson@imm.ki.se
authors.forename: Agneta
authors.initials: A
authors.lastname: Akesson
authors.forename: Thomas
authors.initials: T
authors.lastname: Lundh
authors.forename: Marie
authors.initials: M
authors.lastname: Vahter
authors.forename: Per
authors.initials: P
authors.lastname: Bjellerup
authors.forename: Jonas
authors.initials: J
authors.lastname: Lidfeldt
authors.forename: Christina
authors.initials: C
authors.lastname: Nerbrand
authors.forename: Göran
authors.initials: G
authors.lastname: Samsioe
authors.forename: Ulf
authors.initials: U
authors.lastname: Strömberg
authors.forename: Staffan
authors.initials: S
authors.lastname: Skerfving
mesh_terms: D000118:Acetylglucosaminidase / Q000652:urine; D000510:Alpha-Globulins / Q000652:urine; D002104:Cadmium / Q000097:blood / Q000633:toxicity* / Q000652:urine; D003404:Creatinine / Q000378:metabolism; D055316:Cystatin C; D015891:Cystatins / Q000097:blood; D003920:Diabetes Mellitus; D004781:Environmental Exposure; D004784:Environmental Monitoring; D004785:Environmental Pollutants / Q000097:blood / Q000633:toxicity* / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007678:Kidney Glomerulus / Q000187:drug effects*; D007684:Kidney Tubules / Q000187:drug effects*; D008875:Middle Aged; D012907:Smoking; D013548:Sweden
chemical_list: D000510:Alpha-Globulins; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D004785:Environmental Pollutants; C016001:alpha-1-microglobulin; D002104:Cadmium; D003404:Creatinine; D000118:Acetylglucosaminidase