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Choi SH, Choi KH, Won JU, Kim H. Impact of multi-heavy metal exposure on renal damage indicators in Korea: An analysis using Bayesian Kernel Machine Regression. Medicine (Baltimore) 2023; 102:e35001. [PMID: 37832107 PMCID: PMC10578771 DOI: 10.1097/md.0000000000035001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/08/2023] [Indexed: 10/15/2023] Open
Abstract
Exposure to cadmium (Cd), arsenic (As), and mercury (Hg) is associated with renal tubular damage. People living near refineries are often exposed to multiple heavy metals at high concentrations. This cross-sectional study investigated the association between combined urinary Cd, As, and Hg levels and renal damage markers in 871 residents living near the Janghang refinery plant and in a control area. Urinary Cd, As, Hg, N-acetyl-β-D-glucosaminidase (NAG), and β2-microglobulin (β2-MG) levels were measured. The combined effects of Cd, As, and Hg on renal tubular damage markers were assessed using linear regression and a Bayesian Kernel Machine Regression (BKMR) model. The results of the BKMR model were compared using a stratified analysis of the exposure and control groups. While the linear regression showed that only Cd concentration was significantly associated with urinary NAG levels (β = 0.447, P value < .05), the BKMR model showed that Cd and Hg levels were also significantly associated with urinary NAG levels. The combined effect of the 3 heavy metals on urinary NAG levels was significant and stronger in the exposure group than in the control group. However, no relationship was observed between the exposure concentrations of the 3 heavy metals and urinary β2-MG levels. The results suggest that the BKMR model can be used to assess the health effects of heavy-metal exposure on vulnerable residents.
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Affiliation(s)
- Sun-Haeng Choi
- Department of Occupational and Environmental Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Kyung Hi Choi
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jong-Uk Won
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Heon Kim
- Department of Occupational and Environmental Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
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2
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Wei Y, Lyu Y, Cao Z, Zhao F, Liu Y, Chen C, Li C, Gu H, Lu F, Zhou J, Wu B, Liu Y, Li J, Shi X. Association of low cadmium and mercury exposure with chronic kidney disease among Chinese adults aged ≥80 years: A cross-sectional study. Chin Med J (Engl) 2022; 135:2976-2983. [PMID: 36580647 PMCID: PMC10106162 DOI: 10.1097/cm9.0000000000002395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The heavy metals cadmium (Cd) and mercury (Hg) are known to be widespread environmental contaminants and high occupational exposure adversely affects the risk of chronic kidney disease (CKD). However, evidence from epidemiological studies linking low Cd and Hg exposure (or non-industrial) to the risk of progression to CKD are conflicting. This study aimed to explore the association of low Cd and Hg exposure with the risk of CKD in Chinese adults aged ≥80 years. METHODS The participants were recruited for the Healthy Aging and Biomarkers Cohort Study in 2017, an ongoing perspective survey conducted in longevity areas in China initially involving 3016 older adults. We used logistic regression models to estimate odds ratios (ORs) with 95% confidence intervals of CKD setting Cd and Hg as categorical variables. Logistic regression with restricted cubic spline was used to characterize a dose-response relationships between Cd or Hg concentrations and the risk of CKD in the study population. RESULTS The ORs for the risk of CKD comparing the fourth to the first quartile of blood Cd, blood Hg, urine Cd, and urine Hg were 1.77, 1.57, 2.03, and 1.50, respectively. Restricted cubic spline models showed that blood Cd and urine Hg were significantly linearly correlated with the risk of CKD, while blood Hg and urine Cd were non-linearly correlated with the risk of CKD with a steeper slope at concentrations <2.30 μg/L and 3.30 μg/g creatinine. CONCLUSIONS Our findings suggest that even low Cd and Hg exposure (or non-industrial) were associated with increased risk of CKD in Chinese oldest old, although we did not find a significant multiplicative and additive interaction between Cd and Hg levels in relation to the risk of CKD.
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Affiliation(s)
- Yuan Wei
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
- Department of Hygienic Inspection, School of Public Health, Jilin University, Changchun, Jilin 130021, China
| | - Yuebin Lyu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Zhaojin Cao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Feng Zhao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yingchun Liu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Chengcheng Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Heng Gu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Feng Lu
- Beijing Municipal Health Commission Information Center, Beijing Municipal Health Commission Policy Research Center, Beijing 100034, China
| | - Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Bing Wu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Yang Liu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin 130021, China
| | - Juan Li
- Department of Hygienic Inspection, School of Public Health, Jilin University, Changchun, Jilin 130021, China
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
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3
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Satarug S, Gobe GC, Vesey DA. Multiple Targets of Toxicity in Environmental Exposure to Low-Dose Cadmium. TOXICS 2022; 10:toxics10080472. [PMID: 36006151 PMCID: PMC9412446 DOI: 10.3390/toxics10080472] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 05/06/2023]
Abstract
Dietary assessment reports and population surveillance programs show that chronic exposure to low levels of environmental cadmium (Cd) is inevitable for most people, and adversely impacts the health of children and adults. Based on a risk assessment model that considers an increase in the excretion of β2-microglobulin (β2M) above 300 μg/g creatinine to be the "critical" toxicity endpoint, the tolerable intake level of Cd was set at 0.83 µg/kg body weight/day, and a urinary Cd excretion rate of 5.24 µg/g creatinine was considered to be the toxicity threshold level. The aim of this review is to draw attention to the many other toxicity endpoints that are both clinically relevant and more appropriate to derive Cd exposure limits than a β2M endpoint. In the present review, we focus on a reduction in the glomerular filtration rate and diminished fecundity because chronic exposure to low-dose Cd, reflected by its excretion levels as low as 0.5 µg/g creatinine, have been associated with dose-dependent increases in risk of these pathological symptoms. Some protective effects of the nutritionally essential elements selenium and zinc are highlighted. Cd-induced mitochondrial dysfunction is discussed as a potential mechanism underlying gonadal toxicities and infertility.
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Affiliation(s)
- Soisungwan Satarug
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane 4102, Australia
- Correspondence:
| | - Glenda C. Gobe
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane 4102, Australia
- School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia
- NHMRC Centre of Research Excellence for CKD QLD, UQ Health Sciences, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
| | - David A. Vesey
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane 4102, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane 4075, Australia
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Obert LA, Elmore SA, Ennulat D, Frazier KS. A Review of Specific Biomarkers of Chronic Renal Injury and Their Potential Application in Nonclinical Safety Assessment Studies. Toxicol Pathol 2021; 49:996-1023. [PMID: 33576319 DOI: 10.1177/0192623320985045] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A host of novel renal biomarkers have been developed over the past few decades which have enhanced monitoring of renal disease and drug-induced kidney injury in both preclinical studies and in humans. Since chronic kidney disease (CKD) and acute kidney injury (AKI) share similar underlying mechanisms and the tubulointerstitial compartment has a functional role in the progression of CKD, urinary biomarkers of AKI may provide predictive information in chronic renal disease. Numerous studies have explored whether the recent AKI biomarkers could improve upon the standard clinical biomarkers, estimated glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio, for predicting outcomes in CKD patients. This review is an introduction to alternative assays that can be utilized in chronic (>3 months duration) nonclinical safety studies to provide information on renal dysfunction and to demonstrate specific situations where these assays could be utilized in nonclinical drug development. Novel biomarkers such as symmetrical dimethyl arginine, dickkopf homolog 3, and cystatin C predict chronic renal injury in animals, act as surrogates for GFR, and may predict changes in GFR in patients over time, ultimately providing a bridge from preclinical to clinical renal monitoring.
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Affiliation(s)
- Leslie A Obert
- 549350GlaxoSmithKline (GSK), Nonclinical Safety, Collegeville, PA, USA
| | - Susan A Elmore
- Cellular and Molecular Pathology Branch, National Toxicology Program (NTP), 6857National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Daniela Ennulat
- 549350GlaxoSmithKline (GSK), Nonclinical Safety, Collegeville, PA, USA
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5
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The Effect of Cadmium on GFR Is Clarified by Normalization of Excretion Rates to Creatinine Clearance. Int J Mol Sci 2021; 22:ijms22041762. [PMID: 33578883 PMCID: PMC7916559 DOI: 10.3390/ijms22041762] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 01/13/2023] Open
Abstract
Erroneous conclusions may result from normalization of urine cadmium and N-acetyl-β-D-glucosaminidase concentrations ([Cd]u and [NAG]u) to the urine creatinine concentration ([cr]u). In theory, the sources of these errors are nullified by normalization of excretion rates (ECd and ENAG) to creatinine clearance (Ccr). We hypothesized that this alternate approach would clarify the contribution of Cd-induced tubular injury to nephron loss. We studied 931 Thai subjects with a wide range of environmental Cd exposure. For x = Cd or NAG, Ex/Ecr and Ex/Ccr were calculated as [x]u/[cr]u and [x]u[cr]p/[cr]u, respectively. Glomerular filtration rate (GFR) was estimated according to the Chronic Kidney Disease (CKD) Epidemiology Collaboration (eGFR), and CKD was defined as eGFR < 60 mL/min/1.73m2. In multivariable logistic regression analyses, prevalence odds ratios (PORs) for CKD were higher for log(ECd/Ccr) and log(ENAG/Ccr) than for log(ECd/Ecr) and log(ENAG/Ecr). Doubling of ECd/Ccr and ENAG/Ccr increased POR by 132% and 168%; doubling of ECd/Ecr and ENAG/Ecr increased POR by 64% and 54%. As log(ECd/Ccr) rose, associations of eGFR with log(ECd/Ccr) and log(ENAG/Ccr) became stronger, while associations of eGFR with log(ECd/Ecr) and log(ENAG/Ecr) became insignificant. In univariate regressions of eGFR on each of these logarithmic variables, R2 was consistently higher with normalization to Ccr. Our tabular and graphic analyses uniformly indicate that normalization to Ccr clarified relationships of ECd and ENAG to eGFR.
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6
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Jin Y, Lu Y, Li Y, Zhao H, Wang X, Shen Y, Kuang X. Correlation between environmental low-dose cadmium exposure and early kidney damage: A comparative study in an industrial zone vs. a living quarter in Shanghai, China. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2020; 79:103381. [PMID: 32413495 DOI: 10.1016/j.etap.2020.103381] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
To investigate heavy metal exposure in an industrial zone vs. a living quarter in Shanghai and explore the relationship between the heavy metal source and urine cadmium (Cd) and early kidney damage. Blood lead and urine Cd, manganese (Mn), mercury (Hg), arsenic (As) and EKD indexes were compared between residents in Exposure group (n = 168) and Control group (n = 168). It was found that PM2.5 level in Exposure group was significantly higher than that in Control group, and serum Cys-C and urine Cd, NAG, mAlb, KIM-1 and Cd-MT levels in Exposure group were also significantly higher than those in Control group, suggesting that differences in urine Cd and heavy metal levels between the residents of the two groups may be due to different PM2.5 concentrations in the environments of the two areas. Cd accumulation within the human body can induce kidney damage, probably through its potential hazard to the proximal tubular epithelial cells.
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Affiliation(s)
- Yuanyuan Jin
- Department of Occupational Diseases of Yangpu Hospital Under Yangpu District Central Hospital Affiliated to Tongji University, Shanghai 200090, China
| | - Yiwen Lu
- Department of Occupational Diseases of Yangpu Hospital Under Yangpu District Central Hospital Affiliated to Tongji University, Shanghai 200090, China
| | - Yaying Li
- Physical Examination Center of Jiading District Anting Hospital, Shanghai 201805, China
| | - Huijun Zhao
- Department of Occupational Diseases of Yangpu Hospital Under Yangpu District Central Hospital Affiliated to Tongji University, Shanghai 200090, China
| | - Xuan Wang
- Department of Occupational Diseases of Yangpu Hospital Under Yangpu District Central Hospital Affiliated to Tongji University, Shanghai 200090, China
| | - Yuetian Shen
- Department of Occupational Diseases of Yangpu Hospital Under Yangpu District Central Hospital Affiliated to Tongji University, Shanghai 200090, China
| | - Xingya Kuang
- Department of Occupational Diseases of Yangpu Hospital Under Yangpu District Central Hospital Affiliated to Tongji University, Shanghai 200090, China.
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7
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The Source and Pathophysiologic Significance of Excreted Cadmium. TOXICS 2019; 7:toxics7040055. [PMID: 31635341 PMCID: PMC6958378 DOI: 10.3390/toxics7040055] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/10/2019] [Accepted: 10/16/2019] [Indexed: 12/23/2022]
Abstract
In theory, the identification of the source of excreted cadmium (Cd) might elucidate the pathogenesis of Cd-induced chronic kidney disease (CKD). With that possibility in mind, we studied Thai subjects with low, moderate, and high Cd exposure. We measured urine concentrations of Cd, ([Cd]u); N-acetyl-β-d-glucosaminidase, a marker of cellular damage ([NAG]u); and β2-microglobulin, an indicator of reabsorptive dysfunction ([β2MG]u). To relate excretion rates of these substances to existing nephron mass, we normalized the rates to creatinine clearance, an approximation of the glomerular filtration rate (GFR) (ECd/Ccr, ENAG/Ccr, and Eβ2MG/Ccr). To link the loss of intact nephrons to Cd-induced tubular injury, we examined linear and quadratic regressions of estimated GFR (eGFR) on ECd/Ccr, eGFR on ENAG/Ccr, and ENAG/Ccr on ECd/Ccr. Estimated GFR varied inversely with both ratios, and ENAG/Ccr varied directly with ECd/Ccr. Linear and quadratic regressions of Eβ2MG/Ccr on ECd/Ccr and ENAG/Ccr were significant in moderate and high Cd-exposure groups. The association of ENAG/Ccr with ECd/Ccr implies that both ratios depicted cellular damage per surviving nephron. Consequently, we infer that excreted Cd emanated from injured tubular cells, and we attribute the reduction of eGFR to the injury. We suggest that ECd/Ccr, ENAG/Ccr, and eGFR were associated with one another because each parameter was determined by the tubular burden of Cd.
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8
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Lim S, Yoon JH. Exposure to environmental pollutants and a marker of early kidney injury in the general population: Results of a nationally representative cross-sectional study based on the Korean National Environmental Health Survey (KoNEHS) 2012-2014. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 681:175-182. [PMID: 31103655 DOI: 10.1016/j.scitotenv.2019.04.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/07/2019] [Accepted: 04/06/2019] [Indexed: 06/09/2023]
Abstract
Exposure to environmental pollutants may lead to early kidney injury, chronic kidney disease (CKD) and end-stage renal disease (ESRD). This study investigated the early renal effects associated with exposure to endocrine-disrupting chemicals (EDCs) and heavy metals using general Korean population data. We used data from the Second Korean National Environmental Health Survey (2012-2014). As exposure markers, the concentrations of EDCs, such as triclosan (TCS), bisphenol A (BPA) and phthalate metabolites (DEHP, MnBP and MBzP), and heavy metals, such as cadmium, lead and mercury were analyzed. As an early kidney injury marker, the urinary concentration of β2-microglobulin (β2M) was measured. Multiple linear regression was used to analyze the relationship between environmental pollutants and β2M. A total of 5489 people (male: 2538, female: 2951) aged 19 years and older were enrolled. The geometric mean (GM) concentration of β2M in the total population was 1.88 μg/g creatinine (95% confidence interval (CI) 1.85-1.91). The β2M concentrations were significantly higher in cases of female, old age, low income, and presence of a history of diabetes mellitus or hypertension. The GM concentrations of urinary TCS and cadmium were 1.16 μg/g creatinine (95% CI 1.11-1.21) and 0.57 μg/g creatinine (95% CI 0.57-0.59), respectively. TCS, DEHP, cadmium, lead, and mercury exposure was significantly positively related to urinary β2M in the multiple regression analysis. β2M levels increased significantly with increases in the cadmium, mercury, and lead levels (p for trend <0.0001). The higher the DEHP, MnBP, and TCS concentrations, the higher the β2M level (p for trend <0.01). Environmental pollutants exposure significantly increased urinary β2M levels in the general Korean population. To prevent the development of early kidney injury and CKD, it is important to reduce environmental pollutants exposure through regulatory measures, and cooperation between related bodies in both developing and developed countries.
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Affiliation(s)
- Sinye Lim
- Department of Occupational and Environmental Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea; Department of Occupational and Environmental Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Jin-Ha Yoon
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Republic of Korea.
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9
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Satarug S, Vesey DA, Nishijo M, Ruangyuttikarn W, Gobe GC. The inverse association of glomerular function and urinary β2-MG excretion and its implications for cadmium health risk assessment. ENVIRONMENTAL RESEARCH 2019; 173:40-47. [PMID: 30889420 DOI: 10.1016/j.envres.2019.03.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/28/2019] [Accepted: 03/10/2019] [Indexed: 05/22/2023]
Abstract
Urinary β2-microgroblin (β2-MG) excretion levels above 300 μg/g creatinine are used to indicate defective tubular reabsorption. Arguably, increased urinary β2-MG excretion could also reflect glomerular filtration rate decline. Thus, we investigated an association between urinary β2-MG and estimated glomerular filtration rate (eGFR). We studied 527 subjects, aged 30-87 years (mean 51.2), who lived in a rural area of Thailand polluted with cadmium (Cd). Of this cohort, 10.3% had urinary Cd levels <2 μg/g creatinine and 53.5% had urinary Cd levels ≥5 μg/g creatinine. Half (53.1%) of the participants had urinary β2-MG levels ≥ 300 μg/g creatinine, and 11.6% had low GFR, defined as eGFR <60 mL/min/1.73 m2. Lower eGFR values were associated with older age (β = -0.568, P < 0.001), higher urinary β2-MG (β = -0.170, P < 0.001), higher urinary Cd (β = -0.103, P = 0.005) and diabetes (β = 0.074, P = 0.032). An inverse association between eGFR and urinary β2-MG was evident in subjects with low GFR (β = -0.332, P = 0.033), but not in those with GFR >90 mL/min/1.73 m2 (β = -0.008, P = 0.896). These findings suggested Cd-induced nephron loss and reduced tubular reabsorption in low eGFR subjects. Urinary β2-MG levels <300 μg/g creatinine were associated with 4.66 (95% CI: 1.92, 11.32) fold increase in the POR for low GFR, compared with urinary β2-MG levels <100 μg/g creatinine. Findings in the present study cast doubt on a cut-off value for urinary β2-MG, while lending support to the notion that elevated urinary β2-MG excretion could indicate a fall of GFR.
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Affiliation(s)
- Soisungwan Satarug
- Kidney Disease Research Collaborative, The University of Queensland, Faculty of Medicine and Translational Research Institute, Brisbane, 4102, Australia.
| | - David A Vesey
- Kidney Disease Research Collaborative, The University of Queensland, Faculty of Medicine and Translational Research Institute, Brisbane, 4102, Australia; Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Brisbane, 4075, Australia
| | - Muneko Nishijo
- Department of Public Health, Kanazawa Medical University, Uchinada, Ishikawa, 920-0293, Japan
| | - Werawan Ruangyuttikarn
- Division of Toxicology, Department of Forensic Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Glenda C Gobe
- Kidney Disease Research Collaborative, The University of Queensland, Faculty of Medicine and Translational Research Institute, Brisbane, 4102, Australia; School of Biomedical Sciences, The University of Queensland, Brisbane, 4072, Australia; NHMRC Centre of Research Excellence for CKD, QLD, UQ Health Sciences, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia
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10
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Cui X, Cheng H, Liu X, Giubilato E, Critto A, Sun H, Zhang L. Cadmium exposure and early renal effects in the children and adults living in a tungsten-molybdenum mining areas of South China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:15089-15101. [PMID: 29557043 DOI: 10.1007/s11356-018-1631-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 02/28/2018] [Indexed: 06/08/2023]
Abstract
Adverse health effects related to accumulative cadmium (Cd) exposure have aroused widespread attention from the public in China. Knowledge on the relationships between Cd exposure and early renal effects is particularly limited for children, who are more susceptible to absorbing metals than adults. A typical Cd-polluted area of South China was selected to determine the Cd exposure and related early renal effects of the general population, including children. In total, 211 children and 806 adults were enrolled in the study. The urinary levels of Cd (U-Cd), β2-microglobulin (U-BMG), retinol binding protein (U-RBP), and N-acetyl-β-D-glucosaminidase (U-NAG) were measured. The relationship between U-Cd and ranked indicators of early renal effects was examined by multiple regression analysis. The average U-Cd ranged from 7.01 μg/g creatinine (boys) to 13.55 μg/g creatinine (women) in the Cd-polluted areas. These values are much higher than those of the control group and those that have been reported by other countries. In agreement with previous studies, environmental Cd pollution resulted in elevated Cd accumulation in the bodies of children, and it increased the concentration of NAG in their urine. Similarly, environmental Cd pollution increased NAG and BMG in the urine of adults. Multivariate models showed that the urinary excretion of BMG, RBP, and NAG was positively associated with Cd levels in the urine of both children and adults. The reference thresholds of U-Cd in relation to elevated U-BMG, U-RBP, and U-NAG were higher in children than adults after standardization for other covariates. These results reinforce the need to control and regulate the sources of environmental Cd contamination and to promote more effective risk management measures, especially for vulnerable groups.
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Affiliation(s)
- Xiangfen Cui
- School of Environment, Beijing Normal University, No. 19 Xinjiekouwai Street, Beijing, 100875, People's Republic of China
| | - Hongguang Cheng
- School of Environment, Beijing Normal University, No. 19 Xinjiekouwai Street, Beijing, 100875, People's Republic of China.
| | - Xuelian Liu
- Green Development Institute, Beijing Normal University, Beijing, 100875, People's Republic of China
| | - Elisa Giubilato
- Department of Environmental Sciences, Informatics and Statistics, University Ca' Foscari, Venice, Italy
| | - Andrea Critto
- Department of Environmental Sciences, Informatics and Statistics, University Ca' Foscari, Venice, Italy.
| | - Haixu Sun
- School of Environment, Beijing Normal University, No. 19 Xinjiekouwai Street, Beijing, 100875, People's Republic of China
| | - Lei Zhang
- School of Environment, Beijing Normal University, No. 19 Xinjiekouwai Street, Beijing, 100875, People's Republic of China
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11
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Satarug S. Dietary Cadmium Intake and Its Effects on Kidneys. TOXICS 2018; 6:E15. [PMID: 29534455 PMCID: PMC5874788 DOI: 10.3390/toxics6010015] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 12/11/2022]
Abstract
Cadmium (Cd) is a food-chain contaminant that has high rates of soil-to-plant transference. This phenomenon makes dietary Cd intake unavoidable. Although long-term Cd intake impacts many organ systems, the kidney has long been considered to be a critical target of its toxicity. This review addresses how measurements of Cd intake levels and its effects on kidneys have traditionally been made. These measurements underpin the derivation of our current toxicity threshold limit and tolerable intake levels for Cd. The metal transporters that mediate absorption of Cd in the gastrointestinal tract are summarized together with glomerular filtration of Cd and its sequestration by the kidneys. The contribution of age differences, gender, and smoking status to Cd accumulation in lungs, liver, and kidneys are highlighted. The basis for use of urinary Cd excretion to reflect body burden is discussed together with the use of urinary N-acetyl-β-d-glucosaminidase (NAG) and β2-microglobulin (β2-MG) levels to quantify its toxicity. The associations of Cd with the development of chronic kidney disease and hypertension, reduced weight gain, and zinc reabsorption are highlighted. In addition, the review addresses how urinary Cd threshold levels have been derived from human population data and their utility as a warning sign of impending kidney malfunction.
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Affiliation(s)
- Soisungwan Satarug
- Centre for Kidney Disease Research and Translational Research Institute, The University of Queensland Diamantina Institute and Centre for Health Services Research, Woolloongabba, Brisbane 4102, Australia.
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Argyropoulos CP, Chen SS, Ng YH, Roumelioti ME, Shaffi K, Singh PP, Tzamaloukas AH. Rediscovering Beta-2 Microglobulin As a Biomarker across the Spectrum of Kidney Diseases. Front Med (Lausanne) 2017; 4:73. [PMID: 28664159 PMCID: PMC5471312 DOI: 10.3389/fmed.2017.00073] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/26/2017] [Indexed: 12/28/2022] Open
Abstract
There is currently an unmet need for better biomarkers across the spectrum of renal diseases. In this paper, we revisit the role of beta-2 microglobulin (β2M) as a biomarker in patients with chronic kidney disease and end-stage renal disease. Prior to reviewing the numerous clinical studies in the area, we describe the basic biology of β2M, focusing in particular on its role in maintaining the serum albumin levels and reclaiming the albumin in tubular fluid through the actions of the neonatal Fc receptor. Disorders of abnormal β2M function arise as a result of altered binding of β2M to its protein cofactors and the clinical manifestations are exemplified by rare human genetic conditions and mice knockouts. We highlight the utility of β2M as a predictor of renal function and clinical outcomes in recent large database studies against predictions made by recently developed whole body population kinetic models. Furthermore, we discuss recent animal data suggesting that contrary to textbook dogma urinary β2M may be a marker for glomerular rather than tubular pathology. We review the existing literature about β2M as a biomarker in patients receiving renal replacement therapy, with particular emphasis on large outcome trials. We note emerging proteomic data suggesting that β2M is a promising marker of chronic allograft nephropathy. Finally, we present data about the role of β2M as a biomarker in a number of non-renal diseases. The goal of this comprehensive review is to direct attention to the multifaceted role of β2M as a biomarker, and its exciting biology in order to propose the next steps required to bring this recently rediscovered biomarker into the twenty-first century.
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Affiliation(s)
- Christos P Argyropoulos
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Shan Shan Chen
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Yue-Harn Ng
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Maria-Eleni Roumelioti
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Kamran Shaffi
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Pooja P Singh
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Antonios H Tzamaloukas
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States.,Raymond G. Murphy VA Medical Center Albuquerque, Albuquerque, NM, United States
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Eom SY, Yim DH, Hong SM, Kim YD, Kim H, Choi BS, Park JD, Park CH, Kim GB, Yu SD. Changes in blood and urinary cadmium levels and bone mineral density according to osteoporosis medication in individuals with an increased cadmium body burden. Hum Exp Toxicol 2017; 37:350-357. [DOI: 10.1177/0960327117705425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- S-Y Eom
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - D-H Yim
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - S-M Hong
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Y-D Kim
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - H Kim
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - B-S Choi
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - J-D Park
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - C-H Park
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| | - G-B Kim
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| | - S-D Yu
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
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Kawada T. Cadmium Exposure and Renal Effect in Soldering Iron Workers. Biol Trace Elem Res 2016; 174:484. [PMID: 27154733 DOI: 10.1007/s12011-016-0736-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan.
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Kim YD, Eom SY, Yim DH, Kim IS, Won HK, Park CH, Kim GB, Yu SD, Choi BS, Park JD, Kim H. Environmental Exposure to Arsenic, Lead, and Cadmium in People Living near Janghang Copper Smelter in Korea. J Korean Med Sci 2016; 31:489-96. [PMID: 27051230 PMCID: PMC4810329 DOI: 10.3346/jkms.2016.31.4.489] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/23/2015] [Indexed: 12/02/2022] Open
Abstract
Concentrations of heavy metals exceed safety thresholds in the soil near Janghang Copper Refinery, a smelter in Korea that operated from 1936 to 1989. This study was conducted to evaluate the level of exposure to toxic metals and the potential effect on health in people living near the smelter. The study included 572 adults living within 4 km of the smelter and compared them with 413 controls group of people living similar lifestyles in a rural area approximately 15 km from the smelter. Urinary arsenic (As) level did not decrease according to the distance from the smelter, regardless of gender and working history in smelters and mines. However, in subjects who had no occupational exposure to toxic metals, blood lead (Pb) and cadmium (Cd) and urinary Cd decreased according to the distance from the smelter, both in men and women. Additionally, the distance from the smelter was a determinant factor for a decrease of As, Pb, and Cd in multiple regression models, respectively. On the other hands, urinary Cd was a risk factor for renal tubular dysfunction in populations living near the smelter. These results suggest that Janghang copper smelter was a main contamination source of As, Pb, and Cd, and populations living near the smelter suffered some adverse health effects as a consequence. The local population should be advised to make efforts to reduce exposure to environmental contaminants, in order to minimize potential health effects, and to pay close attention to any health problems possibly related to toxic metal exposure.
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Affiliation(s)
- Yong-Dae Kim
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Sang-Yong Eom
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Dong-Hyuk Yim
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - In-Soo Kim
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Hee-Kwan Won
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Konyang University, Daejeon, Korea
| | - Choong-Hee Park
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| | - Guen-Bae Kim
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| | - Seung-Do Yu
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| | - Byung-Sun Choi
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung-Duck Park
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Heon Kim
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
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Lim H, Lim JA, Choi JH, Kwon HJ, Ha M, Kim H, Park JD. Associations of Low Environmental Exposure to Multiple Metals with Renal Tubular Impairment in Korean Adults. Toxicol Res 2016; 32:57-64. [PMID: 26977259 PMCID: PMC4780232 DOI: 10.5487/tr.2016.32.1.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/15/2015] [Accepted: 01/03/2016] [Indexed: 11/20/2022] Open
Abstract
Recently several studies reported that the renal toxicity of lead (Pb) and cadmium (Cd) may exist in even a low level exposure. In terms of the deterioration of tubular function, it affects the loss of divalent metals and leads to other complications, so renal tubular effect of heavy metals should be well managed. Considering the exposure to heavy metals in reality, it is hard to find the case that human is exposed to only one heavy metal. We designed a cross-sectional study using Korean Research Project on the Integrated Exposure Assessment (KRIEFS) data to investigate the renal effects of multiple metal exposure in general population. We used blood Pb and urinary Cd as exposure measures, and urinary N-acetyl-β-D-glucosaminidase (NAG) and β2-microglobulin (β2-MG) as renal tubular impairment outcome. We conducted linear regression to identify the association between each heavy metal and urinary NAG and β2-MG. And then, we conducted linear regression including the interaction term. Of 1953 adults in KRIEFS (2010~2011), the geometric mean of blood Pb and urinary Cd concentration was 2.21 μg/dL (geometric SD = 1.49 μg/dL) and 1.08 μg/g cr (geometric SD = 1.98 μg/g cr), respectively. In urinary Cd, the strength of the association was also high after adjusting (urinary NAG: β = 0.44, p < 0.001; urinary β2-MG: β = 0.13, p = 0.002). Finally, we identified the positive interactions for the two renal biomarkers. The interaction effect of the two heavy metals of β2-MG was greater than that of NAG. It is very important in public health perspective if the low level exposure to multiple heavy metals has an interaction effect on kidney. More epidemiological studies for the interaction and toxicological studies on the mechanism are needed.
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Affiliation(s)
- Hyungryul Lim
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ji-Ae Lim
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jong Hyuk Choi
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Heon Kim
- Department of Preventive Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jung-Duck Park
- Department of Preventive Medicine, Chung-ang University College of Medicine, Seoul, Korea
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Kawada T. Cadmium burden and its renal effect in inhabitants in a cadmium-contaminated area. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2015; 39:1276-1277. [PMID: 25978868 DOI: 10.1016/j.etap.2015.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/20/2015] [Accepted: 03/29/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Japan.
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