Sensitive indicators of inorganic mercury toxicity

Nephrotoxic Biomarkers with Specific Indications for Metallic Pollutants: Implications for Environmental Health

Environmental and occupational exposure to heavy metals and metalloids is a major global health risk. The kidney is often a site of early damage. Nephrotoxicity is both a major consequence of heavy metal exposure and potentially an early warning of greater damage. A paradigm shift occurred at the beginning of the 21st century in the field of renal medicine. The medical model of kidney failure and treatment began to give way to a social model of risk factors and prevention with important implications for environmental health. This development threw into focus the need for better biomarkers: markers of exposure to known nephrotoxins; markers of early damage for diagnosis and prevention; markers of disease development for intervention and choice of therapy. Constituents of electronic waste, e-waste or e-pollution, such as cadmium (Cd), lead (Pb), mercury (HG), arsenic (As) and silica (SiO₂) are all potential nephrotoxins; they target the renal proximal tubules through distinct pathways. Different nephrotoxic biomarkers offer the possibility of identifying exposure to individual pollutants. In this review, a selection of prominent urinary markers of tubule damage is considered as potential tools for identifying environmental exposure to some key metallic pollutants.

Heavy metal chelation in neurotoxic exposures

Metals such as iron and copper are critical to living organisms, whereas other metals such as lead and arsenic have no known biologic role. Any metals in large amounts may cause toxicity. Many metals cause pervasive systemic effects involving the nervous system, which can be subtle in some cases. Although challenging, the diagnosis and treatment of metal poisoning can be made based on history, physical examination, and the proper use of metal testing. This article focuses on the use, and misuse, of chelation in the diagnosis and management of metal intoxication.

A significant relationship between mercury exposure from dental amalgams and urinary porphyrins: a further assessment of the Casa Pia children's dental amalgam trial

Previous studies noted specific changes in urinary porphyrin excretion patterns associated with exposure to mercury (Hg) in animals and humans. In our study, urinary porphyrin concentrations were examined in normal children 8-18 years-old from a reanalysis of data provided from a randomized, prospective clinical trial that was designed to evaluate the potential health consequences of prolonged exposure to Hg from dental amalgam fillings (the parent study). Our analysis examined dose-dependent correlations between increasing Hg exposure from dental amalgams and urinary porphyrins utilizing statistical models with adjustments for the baseline level (i.e. study year 1) of the following variables: urinary Hg, each urinary porphyrin measure, gender, race, and the level of lead (Pb) in each subject's blood. Significant dose-dependent correlations between cumulative exposure to Hg from dental amalgams and urinary porphyrins associated with Hg body-burden (pentacarboxyporphyrin, precoproporphyrin, and coproporphyrin) were observed. Overall, 5-10% increases in Hg-associated porphyrins for subjects receiving an average number of dental amalgam fillings in comparison to subjects receiving only composite fillings were observed over the 8-year course of the study. In contrast, no significant correlations were observed between cumulative exposure to Hg from dental amalgams and urinary porphyrins not associated with Hg body-burden (uroporphyrin, heptacarboxyporphyrin, and hexacarboxyporphyrin). In conclusion, our study, in contrast to the no-effect results published from the parent study, further establishes the sensitivity and specificity of specific urinary porphyrins as a biomarker for low-level Hg body-burden, and also reveals that dental amalgams are a significant chronic contributor to Hg body-burden.

Urinary porphyrin excretion in children with mercury amalgam treatment: findings from the Casa Pia Children's Dental Amalgam Trial

Increases in the urinary concentrations of pentacarboxyl- and coproporphyrins and the appearance of the atypical precoproporphyrin have been defined in relation to mercury (Hg) body burden in animal studies, and this change in the porphyrin excretion pattern has been described as a biomarker of occupational Hg exposure and toxicity in adult human subjects. In the present studies, urinary porphyrins were determined in relation to Hg exposure in children and adolescents, 8-18 yr of age, over the 7-yr course of a clinical trial designed to evaluate the neurobehavioral and renal effects of dental amalgam in children. Subjects were randomized to either dental amalgam or composite resin treatments. Urinary porphyrins and creatinine concentrations were measured at baseline and annually in all subjects. Results were evaluated using linear regression analysis. No significant differences between treatment groups (amalgam versus composite) were found when comparing all subjects for any of the porphyrins of interest. However, incipent amalgam treatment-specific increases were observed in the mean concentrations of penta-, precopro- and coproporphyrins especially when the analyses were restricted to younger subjects (8 to 9 yr old at baseline), and these increases were most apparent during yr 2 through 3 of follow-up, the period of highest mercury exposure from amalgam treatment. Based on the mean number of amalgam fillings received by children in this group (17.8), the renal Hg concentration associated with incipient increases in urinary porphyrins was estimated to be approximately 2.7 microg/g renal cortex. This value corresponds to an observed mean urinary Hg concentration of 3.2 microg/g creatinine, which is approximately fivefold less than that at which renal damage from Hg exposure is estimated to occur in children. These findings are consistent with growing evidence supporting the sensitivity of urinary porphyrins as a biological indicator of subclinical Hg exposure in children.

Does low mercury containing skin-lightening cream (fair & lovely) affect the kidney, liver, and brain of female mice?

Fair & Lovely is an over-the-counter skin-lightening cream sold widely in Saudi markets. Its mercury content is 0.304+/-0.316 microg/g, in the range of 0.102 to 0.775 microg/g. This study was designed to evaluate its toxic effects on mice. The cream was applied on mice for a period of 1 month at different intervals. Mercury levels were measured in the liver, kidney, and brain tissue samples of a total of 75 adult female CD1 mice by Atomic Absorption Spectrophotometer coupled to a Vapor Generator Accessory. The mean mercury concentrations in the tissues of the treated mice were 0.193+/-0.319 microg/g; whereas for the control group, it was 0.041 microg/g+/-0.041microg/g. While the kidney was found to have the highest mercury content, the brain was found to have the lowest content. Treated mice showed a significant reduction in body weight. Marked histological changes were clearly noted in the kidney and, to a lesser extent, in the brain and liver. These results indicate that although Fair & Lovely mercury content is less than the U.S. Food and Drug Administration (FDA) permissible limits histopathological changes in the brain, kidney, and liver tissues are evidence of its possible toxicity.

Estimation of selected heavy metals and arsenic in PM10 aerosols in the ambient air of the Greater Athens Area, Greece

Aerosol samples of PM(10) were collected during summer and winter 2003 at two different sites in the Messogia Basin northeast of Athens, to demonstrate the variations of heavy metals in PM(10) and examine their relationship with both gaseous pollutants and meteorological parameters. Estimated heavy metals during the experimental campaign were mercury (Hg), cadmium (Cd), lead (Pb), nickel (Ni) and arsenic (As). The average heavy metal concentrations for the first site (Spata) constituted 0.66-14.7ng/m(3) for the summer period and 0.14-19.5ng/m(3) for the winter period. At the second site (Koropi), the corresponding values varied between 0.89 and 13.3ng/m(3) and 0.16 and 24.7ng/m(3), respectively. PM(10) Hg, PM(10) Cd and PM(10) Ni contents showed regular daily variations, with higher mass percentages during the summer, indicating differences in local PM(10) sources for each season. On the contrary, PM(10) Pb presented higher mass percentages during the winter. Examination of the relationship between heavy metals and meteorological parameters indicated a higher correlation with temperature and relative humidity, especially for Pb. In addition, most of the heavy metals (apart from Hg) presented an expected correlation with nitrate oxides (NO(x)), PM(10) and ozone (O(3)). Higher correlations with both meteorological parameters and gaseous pollutants were observed during the winter experimental campaign. Maximum heavy metal concentrations at both sites were observed during days with NE or NNE prevailing winds during the summer campaign, while the winter period was characterized with maximums during days with W or WNW prevailing winds.

Biological monitoring of mercury exposure in individuals referred to a toxicological center in Venezuela

People in developing countries are often considered at greater risk of mercury (Hg) poisoning due to a variety of factors including a lack of awareness regarding their occupational risks. Individuals requiring urine mercury (U-Hg) analysis at the Center for Toxicological Investigations of the University of Carabobo (CITUC), between 1998 and 2002 were studied to identify demographic characteristics associated to U-Hg levels. The studied population included individuals with a history of exposure (or related exposures) to Hg processes, and was comprised of 1159 individuals (65 children, 1094 adults) ages 0.58-79 years old, mean 36.63+/-12.4. Children's geometric mean U-Hg levels were 2.73 microg/g Creatinine (Ct) and in adults 2.55 microg/g Ct. The highest frequency of adults' occupations were shipyard workers (35.47%), dentists (23.5%), lab technicians (11.43%), dental employees 10.42% and miners (10.2%). Chemical laboratory technicians had the highest mean U-Hg (4.46 microg/g Ct). Mean U-Hg levels in female adults (3.45 microg/g Ct) were statistically superior to levels in male adults (2.15 microg/g Ct). Two of the 172 women in reproductive age, had U-Hg levels higher than 78 microg/g Ct. Individuals from Falcon State were found to have the highest mean U-Hg (4.53 microg/g Ct). U-Hg levels higher than permissible limits were found in only 2 states (Carabobo and Bolivar) with a total of 24 cases. Although the results of this investigation were highly variable, the findings can be used to examine circumstances which influence mercury toxicity trends, and possibly used in future studies working to identify Hg exposures.

Change in the iso-enzyme profiles of urinary N-acetyl-beta-D-glucosoaminidase in workers exposed to mercury

The iso-enzyme profiles of urinary N-acetyl-beta-D-glucosoaminidase (NAG) were studied in the workers from a chloro-alkaline electrolysis plant that had been continuously exposed to elemental mercury. The same workers then had a work break of four months and were later re-exposed to mercury for another five months. The activities of urinary NAG in workers exposed to mercury before and after the work break and in the control group were 2.09 +/- 1.03 IU/L; 0.90 +/- 0.52 IU/L and 1.13 +/- 0.35 IU/L, respectively. The fraction of the dominant A form activity in the total activity, in the workers exposed to mercury after a work break (85.31 +/- 5.32%), was almost equal to the fraction of A in the control group (84.64 +/- 2.75%). The percent fraction of A forms (A and A2) during continuous exposure was almost equal to the sum of the fractions A and A2 in the control group and for exposure after the work break. The fraction of the B form activity in the total activity during exposure to elemental mercury for five months after the work break (7.41 +/- 3.45%) was lower (P < 0.1) than the fraction of the B form in the control group (8.62 +/- 2.19%). The decrease in the fraction of the B form compared with the control group was more significant (P < 0.001) in the case of continuously exposed workers (5.25 +/- 2.55%). Beside the major A and B iso-enzymes of NAG, the A2 form was also isolated, and its fraction in the control group (6.73 +/- 2.15%) was not negligible. For workers exposed to mercury for five months, it was 7.28 +/- 3.52%. It is concluded that mercury affected the increased exocytosis of iso-enzyme A and the inhibition of B iso-enzyme of NAG. The increase in activity of urinary NAG in subjects exposed to mercury was a consequence of the increased excretion of A form. It was established also that the four months work break was sufficient for the repair of renal damages that occurred during continuous exposure, and which were monitored by the activity of NAG. Thus, the effects of mercury seem to have been reversible.

Assessing mercury health effects in gold workers near El Callao, Venezuela

Mercury exposure and health status were examined in 40 gold workers in the area surrounding El Callao, Venezuela. Concentrations of mercury in workplace air were measured on 3 successive days, and spot urine and hair samples were also taken for analysis. Subjects underwent a physical examination and completed a questionnaire regarding employment history, work activities involving mercury exposure, use of protective clothing and equipment, and frequency of 37 symptoms associated with mercury toxicity. A complete set of health data was collected for 29 of the subjects. Use of protective equipment was limited, and 17.9%, 24.1%, and 48.3% of subjects had mercury concentrations in air, hair, and urine, respectively, above contemporary occupational exposure guidelines. Physical examination found the workers to be generally healthy and without overt symptoms of mercury toxicity. The frequency of psychoneurological, gastrointestinal, cardio-respiratory, and dermal symptoms was unrelated to any of the measures of mercury exposure. Two subjects had modestly elevated urinary levels of N-acetyl beta-D-glucosaminidase. Despite substantial occupational exposure to mercury among a number of the subjects, few adverse health effects were observed that were plausibly related to mercury.

Effects of mercuric chloride exposure on the glutamate uptake by cultured retinal pigment epithelial cells

The cytotoxicity of mercuric chloride and the effects of mercuric chloride on glutamate and calcium uptake and the factors regulating glutamate uptake were studied in retinal pigment epithelium (RPE) cell cultures. RPE cells isolated from pig eyes and human RPE cell line (D407) cells were cultured to confluency and further subcultured according to the test protocol in question. The cytotoxicity caused by 15 min of exposure to mercuric chloride (0.01--1000 microM) was evaluated by WST-1 assay based on the activity of mitochondrial dehydrogenases. [(3)H]Glutamate uptake was measured after the cells were exposed to 0.1--100 microM mercuric chloride and the selected regulators of protein kinase C (PKC) pathway: PKC activator SC10, PKC inhibitor chelerythrine chloride, phospholipase A(2)/C inhibitor manoalide, tyrosine kinase inhibitor lavendustin A, competitive NMDA receptor antagonist AP7 and IP(3) receptor antagonist heparin. Intracellular calcium was monitored with Fluo-3 probe starting immediately after the exposure to 1--1000 microM mercuric chloride. Mercuric chloride showed concentration-dependent effects on cell viability, on glutamate uptake and on intracellular calcium concentration. The results give some support to the concept that glutamate uptake is affected by PKC. The PKC inhibitor chelerythrine chloride decreased glutamate uptake by 25%, but the PKC activator SC10 could partly prevent the inhibitory effect of mercuric chloride. Lavendustin A, manoalide and heparin had smaller, but statistically significant, effects. All these substances act on mediators which can regulate the activity of PKC. However, PKC is not likely to be the only regulator of glutamate uptake. The rise observed in [Ca(2+)](i) may initiate various cellular events during mercury intoxication.

Pulmonary CT findings in acute mercury vapour exposure

AIM

We describe the pulmonary computed tomography (CT) findings in acute mercury poisoning.

MATERIALS AND METHODS

Initial (n= 8) and follow-up (n= 6) chest CT examinations in eight patients exposed to mercury vapour while cutting pipes in a sulphuric acid plant were reviewed. Of the eight patients, two were asymptomatic and had normal CT results, two were asymptomatic but had abnormalities on CT, and four had both acute symptoms and positive CT results. The patients were all men whose ages ranged from 37 to 54 years (mean, 49 years).

RESULTS

Poorly defined nodules were present in five of six patients with positive CT findings, present alone in two patients or as part of a mixed pattern in three. They were random in distribution. Alveolar consolidation (n= 3) and areas of ground-glass opacity (n= 4) were observed and were more prominent in the most severely affected patients with the highest blood and urine level of mercury, predominantly in the upper and/or middle zone. These abnormal findings on CT resolved with (n= 1) or without (n= 5) steroid therapy. Pathological findings (n= 1) demonstrated acute interstitial changes predominantly with oedema.

CONCLUSION

We report CT findings in eight patients acutely exposed to mercury vapour. The pulmonary injury was reversible on CT in these cases. Hashimoto, M. (2001). Clinical Radiology56, 17-21.

Elimination of mercury from amalgam in rats

The aim of this study was to measure the urinary mercury excretion in rats exposed to amalgam over a two months period. Animals were either exposed to mercury from 4 dental amalgams or fed the diet containing powdered amalgams. The results showed significantly higher mercury amount in urine of both exposed groups than in control. Even two months after the amalgam had been placed in rats teeth, the amount of mercury in the urine remained 4-5 times higher than in control, and 4 times higher than in rats exposed to diet containing powdered amalgam. The elevated urinary Hg amount was accompanied by an increased level of total protein in urine. In the same exposure period the excretion of total protein in urine of rats with amalgam fillings was 2 times higher than in control and 1.5 times higher than in rats exposed to amalgam through diet. Concentrations of mercury in the sera of all groups were below the detection limit of the method. The results show that amount of mercury and protein in the urine of rats were related to the mercury release from dental malgam.

Heavy metal toxicity, Part I: arsenic and mercury

This review is Part I of a two-part series focusing on heavy metal toxicity. Part I will cover arsenic and mercury toxicity. Acute and chronic arsenic toxicity, as well as arsine gas toxicity, will be reviewed. The clinical presentation, with focus on the nervous, cardiovascular, pulmonary, gastrointestinal, hepatic, renal, hematopoietic, and dermatologic systems, is delineated. Mercury exposure, including exposure to short chain alkyl mercury, elemental mercury, and acute inorganic salt, is reviewed. The discussion of clinical toxicity focuses on the nervous, cardiovascular, pulmonary, gastrointestinal, and renal systems, as well as on the teratogenic effects of mercury. Recommendations for diagnostic tests and management plans are discussed, including chelation regimens.

Mercury content in skin-lightening creams and potential hazards to the health of Saudi Women

It seems evident from a wealth of scientific research that mercury is toxic. Because of the nature of the Saudi markets, different brands of skin-lightening creams are widely available. In this study, 38 skin-lightening cream samples were collected and analyzed for mercury by inductively coupled plasma spectrometry after an acid digestion procedure. About 45% of the tested skin-lightening cream samples contained mercury at levels well above the FDA's acceptable limit of 1 ppm. These findings are alarming and have wide legal and educational implications for Saudi Arabia in particular and developing countries in general. Further investigation for possible adverse health effects is also needed.

Effects of exposure to elemental mercury on the nervous system and the kidneys of workers producing natural gas

Early signs of alterations in renal and neurological functions were studied in three groups of workers who were exposed to different levels of mercury that were below the current biological exposure index of 35 microg/g creatinine. There were no differences among the three study groups with respect to either motor nerve conduction velocity or tremor frequency spectra of physiological tremors. Also, no significant correlations were found between the results of the neurological tests and any of the present or historical biological monitoring data. In contrast, N-acetyl-beta-D-glucosaminidase was increased significantly in the group with the higher exposure, compared with either the lower-exposure or control groups. N-acetyl-beta-D-glucosaminidase was correlated strongly with mercury concentration in urine and was correlated weakly with historical biological monitoring data; however, there was no correlation with duration of exposure. These results suggest that after exposure to mercury at levels below the biological exposure index, a transient increase in N-acetyl-beta-D-glucosaminidase can be observed, but is not an early indicator of developing renal dysfunction.

Colour vision loss in workers exposed to elemental mercury vapour

We evaluated colour vision in 33 workers exposed to elemental mercury (Hg) vapour and in 33 referents matched for sex, age, alcohol consumption and cigarette smoking. The results were expressed as colour confusion index (CCI). In the workers urinary excretion of Hg (HgU) ranged from 28 to 287 micrograms/g creatinine. Subclinical colour vision loss, mainly in the blue-yellow range, was observed in the workers. This effect was related to exposure, as indicated by the correlation between HgU and CCI (r = 0.488, P < 0.01). In the workers whose HgU exceeded 50 micrograms/g creatinine, mean CCI was significantly increased compared to the matched referents. The results suggest that exposure to elemental Hg inducing HgU values exceeding 50 micrograms/g creatinine can induce a dose-related colour vision loss.

Subclinical neurotoxicity of mercury vapor revealed by a multimodality evoked potential study of chloralkali workers

Pattern visual, brainstem auditory, and somatosensory evoked potential (EP) studies were performed on 26 chloralkali workers. The intensity of mercury vapor exposure in these workers was estimated from the individual working history. Mercury levels in blood, urine, and hair were determined with atomic absorption spectrometry. The EP findings were compared with those from individually matched normal subjects. In brainstem auditory and somatosensory EP studies, prolonged neural conduction times in the central nervous system (CNS) were found in workers exposed to mercury vapor. In the pattern visual EP study, mercury workers had higher interpeak amplitudes. Findings of this study suggested that chronic exposure to mercury vapor would affect the CNS functions. A multimodality EP study is a useful adjunct in evaluation of chronic mercury neurotoxicity, especially in an epidemiological study.

Fractional mercury levels in Brazilian gold refiners and miners

A field study survey of individuals residing in the region of Para, Brazil, was conducted to determine fractional mercury levels in individuals at risk for exposure in the Brazilian Amazon region. Subjects with a history of exposure to mercury either in the gold mining or refining industry, or exposure to these processes through proximity were included. Three groups were identified as either having recent (less than 2 d since last exposure), intermediate (less than 60 d), or remote (greater than 60 d) exposure to mercury vapors. Fractional blood and urinary mercury levels were assessed for these groups. Group I (recent) had the highest geometric mean blood 24.8 (SD 44.1, range 7.6-158.8) micrograms/L and urine 75.6 (SD 213.4, range 6.5-735.9) micrograms/g-cr (microgram mercury per gram of creatinine) mercury; intermediate (group II) geometric mean blood 7.6 (SD 5.5, range 2.2-19.4) micrograms/L and urine levels 23.8 (SD 84.0, range 7.8-297.0) micrograms/g-cr; the lowest levels in remote exposure (group III): geometric mean blood 5.6 (SD 3.3, range 3.1-14.3) micrograms/L and urine 7.0 (SD 9.8, range 3.1 to 32.9) micrograms/g-cr. The fraction of organic was lowest in group I (32.4%), higher in group II (65.7%), and highest in group III (72.2%). While the frequency of symptoms was comparable in the recent and intermediate groups (2.6 mean, SD 2.3, range 0-8, and 3.1 mean, SD 1.9, range 0-7, symptoms per patient), those with remote exposure demonstrated the highest rate of reporting (6.4 mean, SD 4.1, range 0-11, symptoms per patient). There is significant exposure to mercury for those working in or living near the mining and refining industry. Blood and urine levels are a better marker of recent than remote exposure. The fraction of organic mercury increases with time since exposure. Symptoms may be persistent and low levels of blood and urine mercury do not exclude remote or cumulative toxicity.

Slight renal effect of mercury from amalgam fillings

The current study was to answer the question: Is enough mercury absorbed from dental amalgam fillings to produce renal damage? One hundred healthy adults (18-44 years old) filled out health questionnaires and voided urine samples. Urine mercury concentration and N-acetyl-beta-glucosaminidase (NAG) were measured. Subjects were grouped into those having amalgam fillings (N = 66) and those without (N = 34). Median (95% Confidence Interval) urine mercury was 1 (1-2) and 0 (0-0.6) ng/ml (P < 0.01) and median urine NAG was 23 (18-27) and 16 (11-18) units (P < 0.05) in the two groups respectively. People with mercury amalgam fillings excreted slightly more mercury than people without them, and have a very small increase in urinary NAG excretion that is probably of no clinical significance. This dose of mercury absorbed from amalgam appears to be too little to be a public health hazard for renal injury.

Two-stage evaluation of exposure to mercury and biomarkers of neurotoxicity at a hazardous waste site

Communities surrounding the Rocky Mountain Arsenal (RMA), a Superfund site in Colorado, were studied in order to determine whether exposures to mercury were greater among persons who resided there than among residents of a comparison area 12-15 miles distant. From a census-based stratified random sample, 469 persons were interviewed and urine samples were obtained for biomonitoring. Mercury was detected in urine from 32 (6.8%) of the 469 persons sample at a detection limit of 5 ppb. Trace levels of mercury (detectable, but nonquantifiable) were found in 80 (17.1%) of the persons sampled. Neither the frequency of detection, the arithmetic mean, nor the geometric mean value for urine mercury was found to be statistically different when persons living near the site were compared to persons from the more distant comparison area. The risk of mercury exposure associated with demographic variables, residence, occupation, hobbies, dietary habits, water supply, housing, and activity patterns was evaluated. In the second stage of the evaluation, the Neurobehavioral Core Test Battery (NCTB) is being used to assess individual functional deficits and nervous system disorders associated with exposure to mercury and other neurotoxic chemicals.

The price of gold: mercury exposure in the Amazonian rain forest

Concern has surfaced over the recent discovery of human mercury exposure throughout the tropical rain forest of South America's Amazon River Basin. The probable source of mercury has been traced to gold mines located within the interior. The mining process involves the extraction of gold from ore by burning off a mercury additive, resulting in vaporization of elemental mercury into the surrounding environment. The purpose of this case series is to document mercury levels in miners and local villagers presenting with a history of exposure, or signs and symptoms consistent with mercury toxicity. Over a five year period (1986-91), the whole blood and urine mercury levels of 55 Brazilian patients demonstrating signs and symptoms consistent with mercury exposure were collected. Thirty-three (60%) of the subjects had direct occupational exposure to mercury via gold mining and refining. Whole blood mercury levels ranged from 0.4-13.0 micrograms/dL (mean 3.05 micrograms/dL). Spot urine levels ranged 0-151 micrograms/L (mean = 32.7 micrograms/L). Occupational mercury exposure is occurring in the Amazon River Basin. Interventions aimed at altering the gold mining process while protecting the workers and surrounding villagers from the source of exposure are essential. The impact of the gold mining industry on general environmental contamination has not been investigated.

Markers of early renal changes induced by industrial pollutants. I. Application to workers exposed to mercury vapour

Several markers of renal changes have been measured in a cohort of 50 workers exposed to elemental mercury (Hg) and in 50 control workers. After application of selection criteria 44 exposed and 49 control workers were retained for the final statistical analysis. Exposed workers excreted on average 22 micrograms Hg/g creatinine and their mean duration of exposure was 11 years. Three types of renal markers were studied--namely, functional markers (creatinine and beta 2-microglobulin in serum, urinary proteins of low or high molecular weight); cytotoxicity markers (tubular antigens and enzymes in urine), and biochemical markers (eicosanoids, thromboxane, fibronectin, kallikrein, sialic acid, glycosaminoglycans in urine, red blood cell membrane negative charges). Several bloodborne indicators of polyclonal activation were also measured to test the hypothesis that an immune mechanism might be involved in the renal toxicity of elemental Hg. The main renal changes associated with exposure to Hg were indicative of tubular cytotoxicity (increased leakage of tubular antigens and enzymes in urine) and biochemical alterations (decreased urinary excretion of some eicosanoids and glycosaminoglycans and lowering of urinary pH). The concentrations of anti-DNA antibodies and total immunoglobulin E in serum were also positively associated with the concentration of Hg in urine and in blood respectively. The renal effects were mainly found in workers excreting more than 50 micrograms Hg/g creatinine, which corroborates our previous estimate of the biological threshold of Hg in urine. As these effects, however, were unrelated to the duration of exposure and not accompanied by functional changes (for example, microproteinuria), they may not necessarily represent clinically significant alterations of renal function.

Chronic neurobehavioural effects of elemental mercury in dentists

Neurobehavioural tests were performed by 98 dentists (mean age 32, range 24-49) exposed to elemental mercury vapour and 54 controls (mean age 34, range 23-50) with no history of occupational exposure to mercury. The dentists were exposed to an average personal air concentration time weighted average (TWA) of 0.014 (range 0.0007-0.042) mg/m3 for a mean period of 5.5 (range 0.7-24) years and had a mean blood mercury concentration of 9.8 (range 0.6-57) micrograms/l. In neurobehavioural tests measuring motor speed (finger tapping), visual scanning (trail making), visuomotor coordination and concentration (digit symbol), verbal memory (digit span, logical memory delayed recall), visual memory (visual reproduction, immediate and delayed recall), and visuomotor coordination speed (bender-gestalt time), the performance of the dentists was significantly worse than that of the controls. The dentists scored 3.9 to 38.9% (mean 13.9%) worse in these tests. In trail making, digit span, logical memory delayed recall, visual reproduction delayed recall, and bender-gestalt time test scores were more than 10% poorer. In each of the tests in which significant differences were found and in the block design time, the performance decreased as the exposed dose (product of the TWA of air mercury concentrations and the years of exposure) increased. These results raise the question as to whether the current threshold limit value of 0.050 mg/m3 (TWA) provides adequate protection against adverse effects of mercury.

Effects of occupational exposure to mercury vapour on the central nervous system

Possible effects of mercury on the central nervous system (CNS) were examined in a group of chloralkali workers exposed to mercury (n = 89) and compared with a control group (n = 75), by registration of subjective symptoms, personality changes, forearm tremor, and performance on six computerised psychometric tests in the two groups. The groups were similar in age, education, verbal comprehension, and work tasks. In the chloralkali group, median blood mercury concentration (B-Hg) was 55 nmol/l, serum mercury concentration (S-Hg) 45 nmol/l, and urine mercury concentration (U-Hg) 14.3 nmol/mmol creatinine (25.4 micrograms/g creatinine). Corresponding concentrations in the control group were 15 nmol/l, 4 nmol/l, and 1.1 nmol/mmol creatinine (1.9 micrograms/g creatinine) respectively. The number of self reported symptoms, the scores for tiredness and confusion in the profile of mood states (POMS), and the degree of neuroticism in the Eysenck personality inventory (EPI), were significantly higher in the mercury exposed group compared with the controls. Performance on the psychometric tests and tremor frequency spectra did not differ significantly between the two groups. Dose-response calculations showed weak but statistically significant relations between symptom prevalence and current mercury concentrations in both blood and urine. The performance on three of the psychometric tests was negatively correlated with earlier peak exposures. The findings indicate a slight mercury induced effect on the CNS among the chloralkali workers.

Toxicity of a family from vacuumed mercury

A family of four developed toxic blood levels of mercury after the mother vacuumed a spilled jar of liquid mercury from a closet in their apartment. The youngest son developed severe thrombocytopenia which was initially diagnosed as idiopathic thrombocytopenic purpura secondary to viral illness. A possible association between acute mercury toxicity and idiopathic thrombocytopenic purpura has not been previously reported. Chelation therapy with penicillamine for the older child was administered soon after toxic blood mercury levels were known by the physician. Because thrombocytopenia has been reported to occur in up to 5% of patients receiving penicillamine therapy, the younger child was treated with dimercaptosuccinic acid. The mother was also treated with dimercaptosuccinic acid. The father received dimercaprol therapy. The toxic effects and rationale for now outdated therapeutic uses of mercury are discussed.

Psychiatric manifestations of mercury poisoning

Mercury and its compounds are toxic substances that are widely used in industry and agriculture. Mercury poisoning is an uncommon but important clinical entity that often presents with psychiatric disturbances as a prominent part of the clinical picture. In this paper, a case of mercury poisoning in a 12-year-old girl with prominent psychiatric manifestations is presented. Relevant literature concerning the psychiatric manifestations of mercury poisoning is discussed. The importance of considering mercury poisoning, and toxic conditions in general, in the differential diagnosis of psychiatric disorders is emphasized.

Amalgam hazards. An assessment of research

Although mercury vapor in high concentration can have deleterious effects on several organ systems, there is no evidence of risk at the levels generated by chewing with amalgam restorations. Epidemiological studies relating amalgam exposure to health outcomes are recommended, however, to provide the profession and the public a full sense of security.

On-site screening for urinary Hg concentrations and correlation with glomerular and renal tubular function

At the American Dental Association 1985 and 1986 Annual Sessions, an on-site screening for mercury was conducted as part of the Health Screening Program (HSP) to identify dentists having elevated urinary mercury concentrations. The data generated from this study were used to examine the relationship between elevated urinary mercury exposure and kidney dysfunction. Kidney dysfunction was assessed by measurement of serum and urine beta 2 microglobulin concentrations, serum creatinine, and creatinine clearance. The mean values found for urinary mercury were 5.8 micrograms Hg/L and 7.6 micrograms Hg/L for 1985 and 1986, respectively. Urinary mercury concentrations for this population were found to fall within the range of not detected to 115 micrograms Hg/L. Of the total number of participants assayed in 1985 and 1986, roughly 10 percent of the sample exhibited elevated mercury concentrations above 20 micrograms Hg/L. An analysis of the clinical markers indicated no clear relationship between elevated urinary mercury concentrations and kidney dysfunction. In addition to mercury testing, all dentists who participated in the 1985 and 1986 HSP were issued a questionnaire soliciting information as to their professional exposure. Those participants who were identified as having elevated urinary mercury concentrations in the 1985 HSP were issued a followup questionnaire that addressed psychological and neuropsychological symptoms. From these questionnaires three significant relationships were found. These relationships were associated with mercury/amalgam handling and skin contact, the number of amalgams placed by the dentist, and the number of hours of practice per week. The reported absence of a clear relationship between urinary mercury concentrations and potential kidney dysfunction is in agreement with other findings at the mercury concentrations tested.(ABSTRACT TRUNCATED AT 250 WORDS)

Differences in frequency of finger tremor in otherwise asymptomatic mercury workers

Tremor was measured from the index finger during low force, position holding in 18 control subjects and 18 battery workers with low level exposure to mercury. All workers were asymptomatic on clinical neurological examination. No differences were found in average tremor amplitudes between the groups, but statistically significant abnormalities in tremor frequency distribution existed. Tremor power spectra in the group of mercury workers were shifted toward the higher frequencies and compressed into narrow frequency peaks. These results suggest that measurements of finger tremor that evaluate the frequency distribution can produce a higher diagnostic yield than traditional visual clinical judgement. The findings also confirm other reports that currently permitted exposures to mercury are associated with subtle but distinctive differences in tremor accompanying voluntary movement.

Mercury exposure from interior latex paint

BACKGROUND

Many paint companies have used phenylmercuric acetate as a preservative to prolong the shelf life of interior latex paint. In August 1989, acrodynia, a form of mercury poisoning, occurred in a child exposed to paint fumes in a home recently painted with a brand containing 4.7 mmol of mercury per liter (at that time the Environmental Protection Agency's recommended limit was 1.5 mmol or less per liter).

METHODS

To determine whether the recent use of that brand of paint containing phenylmercuric acetate was associated with elevated indoor-air and urinary mercury concentrations, we studied 74 "exposed" persons living in 19 homes recently painted with the brand and 28 "unexposed" persons living in 10 homes not recently painted with paint containing mercury.

RESULTS

The paint samples from the homes of exposed persons contained a median of 3.8 mmol of mercury per liter, and air samples from the homes had a median mercury content of 10.0 nmol per cubic meter (range, less than 0.5 to 49.9). No mercury was detected in paint or air samples from the homes of unexposed persons. The median urinary mercury concentration was higher in the exposed persons (4.7 nmol of mercury per millimole of creatinine; range, 1.4 to 66.5) than in the unexposed persons (1.1 nmol per millimole; range, 0.02 to 3.9; P less than 0.001). Urinary mercury concentrations within the range that we found in exposed persons have been associated with symptomatic mercury poisoning.

CONCLUSIONS

We found that potentially hazardous exposure to mercury had occurred among persons whose homes were painted with a brand of paint containing mercury at concentrations approximately 2 1/2 times the Environmental Protection Agency's recommended limit.

Environmentally related diseases of the urinary tract

Nephrotoxicity from exposure to therapeutic agents and chemicals in the environment and workplace results in a broad spectrum of clinical renal disease that may mimic disorders from other causes. Nephrotoxic agents may, in fact, be responsible for some fraction of renal disease of undetermined etiology. Specific diagnosis and treatment by removal from exposure to the toxic agent is more likely in the early phase of the disorder. Measurement and characterization of proteinuria provides the most sensitive and reliable method of early detection. Increased urinary excretion of serum proteins with molecular weight in excess of 50,000, such as albumin and transferrin, is an early indicator of glomerular injury. Low-molecular-weight proteinuria (beta 2-microglobulin or retinol-binding protein) and enzymuria, particularly excretion of NAG, are sensitive indicators of renal tubular cell injury. Tests that reflect hypersensitivity reactions are often indicative of immunologically mediated nephrotoxicity but are not specific for the kidney. Cancers of the kidney and urinary bladder appear to be increasing and are most common among the socially active and affluent. Susceptibility of the urinary tract to toxicity and carcinogenicity reflect contact of excreted toxins with the epithelial cells of nephrons and urinary bladder.

Hemodynamic and electrophysiological effects of mercury in intact anesthetized rabbits and in isolated perfused hearts

Using intact anesthetized rabbits and isolated perfused hearts, the hemodynamic and electrophysiological effects of mercury (Hg) were examined in order to assess the role of cardiovascular dysfunction in Hg intoxication. The most consistent and prominent cardiovascular effect was a significant reduction in blood pressure. This cardiodepressive action was probably brought about by the primary action of Hg on the heart rather than by altered sympathetic activity, as evidenced by normal renal nerve activity at times when the hemodynamic actions of Hg were clearly manifest. Although the principal target organ for the toxic actions of inorganic Hg is the kidney, chronic exposure to both inorganic and organic Hg frequently results in signs and symptoms of CNS dysfunction. The profound hemodynamic effects of Hg that we have observed emphasize the potential importance of Hg cardiotoxicity and indicate the need to differentiate between the primary and the secondary effects of Hg intoxication on CNS tissues for evaluation of the toxic effects of Hg compounds.

Renal function and long-term low mercury vapor exposure

Renal function indicated by urinary albumin and N-acetyl-beta-glucosaminidase was studied among a group of male chlorine-alkali workers (N = 60) and their matched referents (N = 60). Exposure to mercury vapor had occurred at least 5 y (mean 13.7 y; SD 5.5 y). The estimated long-term exposure level calculated from the time-weighted average blood concentrations of mercury had been approximately 25 micrograms/m3 of air. Neither glomerular nor tubular effects were shown in the exposed workers.

Epidemiological application of early markers of nephrotoxicity

This paper is a review of epidemiological studies in which sensitive markers of nephrotoxicity have been used to detect the early effects of chemicals on the kidney. Most of the studies are cross-sectional, and their objective was either to identify potentially nephrotoxic chemicals (organic solvents, heavy metals) in the working or general environment or to establish dose-response/effect relationships from which safe exposure levels can be defined (e.g., for cadmium and mercury vapour). A few longitudinal studies were conducted to determine the persistence of renal disturbances and to get information on their predictive value (e.g., microproteinuria in cadmium workers). Nephrotoxicity tests, which have proved to be the most useful in these epidemiological studies, rely on the determination of specific urinary proteins which, according to their size, reflect the functional integrity of the proximal tubule (e.g., retinol-binding protein or beta 2-microglobulin) or the glomerulus (e.g., albumin, immunoglobulin G). An increased urinary excretion of the lysosomal enzyme N-acetyl-beta-D-glucosaminidase has been reported in several studies (e.g., in lead-exposed workers), but the pathological significance of this finding remains to be clarified, particularly when it is not associated with changes in the urinary excretion of specific proteins. Further work is needed to assess the usefulness of tests introduced more recently such as the assay of renal antigens in urine and the use of red-blood-cell membrane negative charges as an index of the glomerular polyanion. With the exception of microproteinuria observed in chronic cadmium poisoning, no epidemiological data are available on the prognostic value of subclinical renal effects caused by nephrotoxic chemicals.

Renal tubular function of workers exposed to low levels of cadmium

Cadmium induced renal tubular effects were examined in 65 female workers in a factory manufacturing nickel cadmium batteries. Urinary beta 2-microglobulin (beta 2m), urinary N-acetyl-D-glucosaminidase activity (NAG), and serum creatinine and serum urea concentrations were used to assess the renal effects. Of the four measures, only urinary NAG and urinary beta 2m showed a strong positive correlation with blood cadmium concentrations (r = 0.49 and 0.43 respectively); NAG showed a weaker correlation with urinary cadmium concentrations (r = 0.35). Urinary beta 2m has weak correlation with urinary cadmium (r = 0.04). Only urinary NAG showed a significant deterioration in renal function among the exposed group. NAG detects the largest proportion of abnormalities among the exposed group. Abnormal urinary beta 2m is detected in only 15.4% of the workers, half of whom have blood cadmium above 10 micrograms/l. The proportion of abnormalities detected by urinary NAG differs significantly from the proportion of abnormalities detected by urinary beta 2m (p less than 0.01). The age adjusted mean urinary NAG excretion showed a significant rise with urinary cadmium of above 3 micrograms/g creatinine. Urinary beta 2m failed to show any significant rise. With blood cadmium concentrations, the age adjusted mean urinary NAG excretion showed a rise from 1 microgram/l of blood cadmium followed by a plateau between blood cadmium concentrations of 3-10 micrograms/l. No significant rise in mean urinary excretion in beta 2m was seen until blood cadmium concentrations exceeded 10 micrograms/l.

Acute mercury poisoning and mercurial pneumonitis from gold ore purification

We describe four men who had symptoms of acute mercury poisoning following exposure to mercury vapor. They were attempting home gold ore purification using a gold-mercury amalgam and sulfuric acid. Three of the four patients required treatment with penicillamine. The clinical and laboratory data are presented along with pulmonary function test results. Long-term follow-up of one patient indicates residual morbidity, with continued reduction in pulmonary diffusing capacity. This suggests permanent impairment of pulmonary function despite prompt chelation therapy.