title: Mercury-associated nephrotic syndrome: a case report and systematic review of the literature.
abstract: Kidney injury from mercury is known to cause dose-related tubular dysfunction and idiosyncratic nephrotic syndrome according to various case reports. Motivated by a patient with subacute-onset nephrotic syndrome, histologic features of secondary focal segmental glomerulosclerosis, and concurrent mercury toxicity, we conducted a systematic review to explore renal histologic changes in patients with toxic mercury exposures and nephrotic syndrome. Data were extracted from a patient's clinical record. MEDLINE/Ovid was searched from 1950 to November 2010 using a prespecified search strategy. Two nephrology textbooks and the UpToDate online database also were searched. Inclusion criteria were studies of humans with nephrotic syndrome, nephrotic-range proteinuria, or kidney biopsy results reported. There were no exclusion criteria. We identified 27 other reports of 42 patients with nephrotic syndrome or nephrotic-range proteinuria. Of the 26 individuals, including our patient, who underwent kidney biopsy, histology showed glomerular disease in 21. Of these 20 biopsies, 4 showed minimal change disease and 15 showed membranous glomerulonephritis. Mercury exposure can lead to various glomerular lesions; we emphasize the importance of a careful occupational and dietary history in elucidating a cause for the undetermined nephrotic syndrome.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Saul
authors.initials: S
authors.lastname: Miller
authors.forename: Shelley
authors.initials: S
authors.lastname: Pallan
authors.forename: Azim S
authors.initials: AS
authors.lastname: Gangji
authors.forename: Dusan
authors.initials: D
authors.lastname: Lukic
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Clase
mesh_terms: D000818:Animals; D004781:Environmental Exposure / Q000009:adverse effects; D005399:Fishes; D005618:Fresh Water; D006801:Humans; D008297:Male; D008628:Mercury / Q000008:administration & dosage / Q000652:urine*; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000175:diagnosis* / Q000652:urine*
chemical_list: D008628:Mercury