Acute mercury nephrotoxicity will manifest as acute renal failure
due to acute tubular necrosis associated with erosive gastritis,
haematemesis and melena.
Chronic mercury nephrotoxicity will manifest as tubulo-
interstitial nephritis or nephrotic syndrome (due to membranous
nephropathy or nil-change disease or less commonly anti-GBM disease)
which is associated with neurologic deficits.
Treatment: Acute toxicity is treated with BAL and chronic
toxicity by removal from the source of exposure.
Arsenic nephrotoxicity:
Elemental arsenic is not toxic, but the pentavalent, trivalent salts
and arsine gas (Arsine) are very toxic.
Exposure:
- Industry: glass, pigment, bronze plating or metal alloys.
- Wood preservation, veterinary medicine, herbicides, insecticides and
rodenticides. - Certain herbal preparations, burning of arsenic-treated wood or
arsenic containing prescription medicines. - Arsine can be released from sewage plants.
Clinical manifestations of arsenic nephrotoxicity:
a) Acute exposure (for example arsine gas): Acute renal failure (ATN),
haemolytic anemia, cardiomyopathy, encephalopathy, epigastric
pain, vomiting and explosive diarrhoea. This is usually fatal and
those who recover develop chronic renal failure.