Kidney and heavy metals - The role of environmental exposure (Review).
Heavy metals are extensively used in agriculture and industrial applications such as production of pesticides, batteries, alloys, and textile dyes. Prolonged, intensive or excessive exposure can induce related systemic disorders. Kidney is a target organ in heavy metal toxicity for its capacity to filter, reabsorb and concentrate divalent ions. The extent and the expression of renal damage depends on the species of metals, the dose, and the time of exposure. Almost always acute kidney impairment differs from chronic renal failure in its mechanism and in the magnitude of the outcomes. As a result, clinical features and treatment algorithm are also different. Heavy metals in plasma exist in an ionized form, that is toxic and leads to acute toxicity and a bound, inert form when metal is conjugated with metallothionein and are then delivered to the liver and possible causing the kidney chronic damage. Treatment regimens include chelation therapy, supportive care, decontamination procedures and renal replacement therapies. This review adds specific considerations to kidney impairment due to the most common heavy metal exposures and its treatment.
Department of Nephrology and Dialysis, 'St. Bassiano' Hospital, I-36061 Bassano del Grappa, Italy.
Paolo
P
Lentini
Department of Internal Medicine, University of Catania, I-95124 Catania, Italy.
Luca
L
Zanoli
Department of Nephrology 'St. Giovanni di Dio' Hospital, I-92100 Agrigento, Italy.
Antonio
A
Granata
Department of Internal Medicine, University of Catania, I-95124 Catania, Italy.
Salvatore Santo
SS
Signorelli
Department of Internal Medicine, University of Catania, I-95124 Catania, Italy.
Pietro
P
Castellino
Department of Nephrology and Dialysis, 'St. Bassiano' Hospital, I-36061 Bassano del Grappa, Italy.
Roberto
R
Dell'Aquila
D000970:Antineoplastic Agents / Q000633:toxicity; D002614:Chelating Agents / Q000627:therapeutic use; D002945:Cisplatin / Q000633:toxicity; D004781:Environmental Exposure; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D019216:Metals, Heavy / Q000378:metabolism / Q000633:toxicity*; D006435:Renal Dialysis; D017582:Renal Replacement Therapy
D000970:Antineoplastic Agents; D002614:Chelating Agents; D019216:Metals, Heavy; D002945:Cisplatin