Acute lead nephropathy:
This may manifest as acute renal failure with Fanconi syndrome
and systemic disease including abdominal colic, anorexia, vomiting,
constipation, anaemia, peripheral neuropathy and encephalopathy.
Lead containing inclusion bodies will be detected in renal tubular
cells, urine, liver, neural tissue and osteoblasts.
Good responses can be achieved by chelation therapy (EDTA,
BAL and Penicillamine).
Chronic lead nephropathy:
Histologically, it will appear as a slowly progressive
tubulointerstitial nephritis. Clinically, this manifests as chronic renal
failure, hypertension, hyperuricaemia and gout. These manifestations are
associated with others, including gastrointestinal, haematologic and
neurologic. The diagnosis is confirmed with the detection of an abnormal
body lead level >80 ug/L and positive EDTA lead chelation test. In the
hypertensive gouty patient with chronic renal failure and without stone
disease, chelation test may detect an unrecognized lead exposure.
Chronic lead nephropathy, especially if diagnosed and treated early
could be arrested or its progression is retarded.
Ca Na 2 EDTA is given in combination with BAL for symptomatic
cases.