title: Minimal change disease caused by exposure to mercury-containing skin lightening cream: a report of 4 cases.
abstract: Mercury is a known cause of nephrotic syndrome and the underlying renal pathology in most of the reported cases was membranous nephropathy. We describe here 4 cases of minimal change disease following exposure to mercury-containing skin lightening cream for 2 - 6 months. The mercury content of the facial creams was very high (7,420 - 30,000 parts per million). All patients were female and presented with nephrotic syndrome and heavy proteinuria (8.35 - 20.69 g/d). The blood and urine mercury levels were 26 - 129 nmol/l and 316 - 2,521 nmol/d, respectively. Renal biopsy revealed minimal change disease (MCD) in all patients. The use of cosmetic cream was stopped and chelation therapy with D-penicillamine was given. Two patients were also given steroids. The time for blood mercury level to normalize was 1 - 7 months, whereas it took longer for urine mercury level to normalize (9 - 16 months). All patients had complete remission of proteinuria and the time to normalization of proteinuria was 1 - 9 months. Mercury-containing skin lightening cream is hazardous because skin absorption of mercury can cause minimal change disease. The public should be warned of the danger of using such products. In patients presenting with nephrotic syndrome, a detailed history should be taken, including the use of skin lightening cream. With regard to renal pathology, apart from membranous nephropathy, minimal change disease should be included as another pathological entity caused by mercury exposure or intoxication.
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China. tanghl@ha.org.hk
authors.forename: Hon-Lok
authors.initials: HL
authors.lastname: Tang
authors.forename: Yuen-Fun
authors.initials: YF
authors.lastname: Mak
authors.forename: Kwok-Hong
authors.initials: KH
authors.lastname: Chu
authors.forename: William
authors.initials: W
authors.lastname: Lee
authors.forename: Samuel Kaâ Shun
authors.initials: SK
authors.lastname: Fung
authors.forename: Thomas Yan-Keung
authors.initials: TY
authors.lastname: Chan
authors.forename: Kwok-Lung
authors.initials: KL
authors.lastname: Tong
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D001706:Biopsy; D002614:Chelating Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D017669:Mercury Compounds / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood / Q000652:urine; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism; D010396:Penicillamine / Q000627:therapeutic use; D011507:Proteinuria / Q000139:chemically induced; D012869:Skin Absorption; D063465:Skin Cream; D062327:Skin Lightening Preparations / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D012880:Skin Pigmentation / Q000187:drug effects*; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002614:Chelating Agents; D017669:Mercury Compounds; D062327:Skin Lightening Preparations; D013256:Steroids; D010396:Penicillamine