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1.
Med Lav ; 102(3): 243-9, 2011.
Artículo en Italiano | MEDLINE | ID: mdl-21797041

RESUMEN

BACKGROUND: Acute lead poisoning due to food intake is exceptional in adults and often associated with mental illness OBJECTIVES: to describe a case report of acute lead intoxication with haemolytic anemia and lead colic. METHODS: A 41-year old male patient was admitted to hospital for abdominal pain and persistent constipation. Abdominal X-ray showed a radiopaque mass in the caecum and progressive anaemia was observed The patient was discharged with a diagnosis of bowel obstruction. Due to persistence of the symptoms he was again hospitalized; abdominal X-ray showed diffuse radiopaque particles in the colon and haemoglobin (hb) had dropped to 8.7 g/dl. Blood levels of lead and zinc protoporphryin were 106.7 microg/dl and 6.6 microg/gHb, respectively. The timely start of chelating therapy led to a rapid return to normal peripheral blood counts and a decline in blood lead levels. RESULTS: Although acute lead poisoning due to intake with food is exceptional in adults and often associated with mental illness, in this case, it was not possible to clarify the route and vehicle of ingestion of the toxic. Lead body burden was shown as a caecal mass, probably as a result of ingesting a single bolus of lead dust which, considering the size and density of the mass, was estimated as weighing several grammes. This acute lead intake induced an acute haemolysis due to enhanced fragility of the erythrocyte membrane. CONCLUSIONS: In the course of acute lead intoxication, the critical organ is not the bone marrow, but rather the red blood cell, leading to haemolysis and anaemia.


Asunto(s)
Anemia Hemolítica/inducido químicamente , Cólico/inducido químicamente , Intoxicación por Plomo/complicaciones , Enfermedad Aguda , Adulto , Ciego/diagnóstico por imagen , Quelantes/uso terapéutico , Terapia por Quelación , Estreñimiento/etiología , Ingestión de Alimentos , Ácido Edético/uso terapéutico , Humanos , Hiperbilirrubinemia/inducido químicamente , Plomo/sangre , Intoxicación por Plomo/sangre , Intoxicación por Plomo/diagnóstico , Intoxicación por Plomo/diagnóstico por imagen , Masculino , Polvos , Protoporfirinas/sangre , Radiografía
2.
Nephrol Dial Transplant ; 11(4): 628-34, 1996 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-8671850

RESUMEN

BACKGROUND: In this study we investigated whether the increase in proteinuria induced by an oral protein load may be prevented by the angiotensin-converting enzyme inhibitor (ACEI) captopril in patients with nephrotic syndrome, and whether the effects of captopril on renal haemodynamics and/or glomerular selectivity are comparable to those obtained with the nonsteroidal anti-inflammatory drug (NSAID) indomethacin and the calcium-channel blocker (CaCB) nifedipine. METHODS: Twelve subjects underwent the following treatments: (1) low-protein meal (0.2 g protein/kg body wt), (2) high-protein meal (1.3 g protein/kg body wt), (3) high-protein meal plus oral captopril (50 mg), (4) high-protein meal plus oral nifedipine (10 mg), (5) high-protein meal plus oral indomethacin (50 mg). Urine and blood samples were obtained after meals and tested for total protein, immunoglobulin G and albumin. GFR and renal plasma flow (RPF) were calculated from iothalamate and p-aminohippuric acid clearances respectively. RESULTS: Mean arterial pressure decreased significantly after both captopril (-4%, P = 0.001) and nifedipine (-5%, P = 0.0019). Compared with the low-protein meal, mean values of GFR and RPF increased significantly after the high-protein meal alone (+21%, P = 0.0002; +10%, P = 0.0491 respectively), and after captopril (+18%, P = 0.0025; +24%, P = 0.0034 respectively) or nifedipine administration (+30%, P = 0.0001; +21%, P = 0.0036 respectively), whereas they remained unchanged after the high-protein meal plus indomethacin administration. FF did not change significantly under the five experimental conditions. The increase in urinary protein excretion induced by the meat load (total protein +18%, P = 0.0102; albumin +26%, P = 0.0316; IgG +28%, P = 0.0203) was entirely blocked by both captopril and indomethacin, whereas it was further increased by nifedipine administration. CONCLUSIONS: Both captopril and indomethacin, but not nifedipine, are able to prevent the increase in urinary protein excretion rate following a meat meal. The antiproteinuric effect of captopril is comparable to that of indomethacin, but the renal haemodynamic changes induced by these drugs differ considerably, because the filtration capacity and the renal functional reserve were preserved by captopril and decreased by indomethacin. The reduction in systemic blood pressure following administration of both captopril and nifedipine does not account for changes in proteinuria, since, with a similar degree of blood pressure lowering, urinary protein excretion is reduced by captopril and increased by nifedipine.


Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Captopril/uso terapéutico , Proteínas en la Dieta/administración & dosificación , Indometacina/uso terapéutico , Riñón/efectos de los fármacos , Síndrome Nefrótico/complicaciones , Nifedipino/uso terapéutico , Proteinuria/prevención & control , Adolescente , Adulto , Anciano , Análisis de Varianza , Presión Sanguínea/efectos de los fármacos , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Síndrome Nefrótico/dietoterapia , Proteinuria/etiología , Sodio/orina
3.
Hum Exp Toxicol ; 15 Suppl 1: S10-9, 1996 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-8882556

RESUMEN

Within the framework of an European Commission-funded project, groups of industrial workers exposed to heavy metals (cadmium, mercury and lead) or solvents were studied together with corresponding control groups. Eighty-one measurements were carried out on urine and serum samples and the scientific results together with individual questionnaire information were entered into a central database. Data obtained was assessed centrally and individually in subsidiary studies. The measurable contributions were assessed either singly or in combination, of smoking, gender, metal exposure and site, to nephrotoxicity. The potential value of each test as an indicator of nephrotoxicity was then assessed on the basis of sensitivity and specificity. A number of new tests including prostaglandins and for extracellular matrix components were investigated as well as established tests for renal damage and dysfunction. The data obtained from this comprehensive study emphasises the value of noninvasive biomarkers for the early detection of nephrotoxicity due to environmental toxins. The urinary profile varied with the type of environmental/occupational toxin. By careful selection of a small panel of markers they can be used to indicate the presence of renal damage, the principal region affected, and to monitor the progress of disease and damage. Biomarkers were also used to confirm and tentatively establish safe exposure levels to nephrotoxins.


Asunto(s)
Evaluación Preclínica de Medicamentos , Contaminantes Ambientales/toxicidad , Riñón/efectos de los fármacos , Biomarcadores , Evaluación Preclínica de Medicamentos/métodos , Evaluación Preclínica de Medicamentos/normas , Evaluación Preclínica de Medicamentos/tendencias , Humanos
4.
Environ Res ; 58(1): 35-54, 1992 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-1317791

RESUMEN

Male Sprague-Dawley rats were exposed to high-dose (0.5%) lead acetate for periods ranging from 1 to 9 months; then lead exposure was discontinued, and animals were sacrificed after 12 months. Controls were pair-fed. Two additional groups of low-dose (0.01%) and high-dose (0.5%) rats were exposed to lead for 6 months, then lead was discontinued and the rats were treated with three 5-day courses of 0.5% DMSA (dimercaptosuccinic acid) over the next 6 months. Controls were rats exposed to lead for 6 months, then removed from exposure for 6 months without receiving DMSA. Low-dose lead-treated rats showed no significant pathological changes with or without DMSA treatment, but exhibited a significant increase in GFR after DMSA. High-dose lead-treated animals showed no functional or pathological changes when lead exposure was discontinued after 1 month. However, when duration of exposure was 6 or 9 months, GFR was decreased and serum creatinine and urea nitrogen were increased as compared to controls. Tubulointerstitial disease was severe. Administration of DMSA resulted in an improvement in GFR and a decrease in albuminuria, together with a reduction in size and number of nuclear inclusion bodies in proximal tubules. However, tubulointerstitial scarring was only minimally reduced. It may be concluded that, except for brief initial exposure, discontinuation of high-dose lead exposure fails to reverse lead-induced renal damage. Treatment with the chelator, DMSA, improves renal function but has less effect on pathological alterations. As GFR improved after DMSA treatment in both low-dose and high-dose lead-treated rats, irrespective of the degree of pathological alterations, it may be concluded that the DMSA effect is most likely mediated by hemodynamic changes.


Asunto(s)
Enfermedades Renales/inducido químicamente , Riñón/efectos de los fármacos , Intoxicación por Plomo/complicaciones , Plomo/toxicidad , Succímero/uso terapéutico , Acetilglucosaminidasa/orina , Albuminuria/diagnóstico , Animales , Nitrógeno de la Urea Sanguínea , Creatinina/orina , Membrana Eritrocítica/enzimología , Tasa de Filtración Glomerular , Glutatión Transferasa/orina , Hematócrito , Riñón/patología , Riñón/fisiología , Riñón/ultraestructura , Enfermedades Renales/tratamiento farmacológico , Plomo/administración & dosificación , Intoxicación por Plomo/tratamiento farmacológico , Masculino , Ratas , Ratas Endogámicas , Silicio/análisis , ATPasa Intercambiadora de Sodio-Potasio/sangre
5.
Am J Ind Med ; 11(2): 177-87, 1987.
Artículo en Inglés | MEDLINE | ID: mdl-3493689

RESUMEN

We examined sensitive biochemical and immunological markers of kidney function and damage in 53 male oil refinery workers exposed to hydrocarbons and compared their results with those of a control group of 61 age-matched nonexposed males. The mean duration of employment of exposed males was 11 years. The current levels of exposure to a variety of aliphatic and aromatic hydrocarbons, as determined by personal monitoring, were well below the current threshold limit values. No difference was found in the urinary tubular parameters beta-N-acetyl-D-glucosaminidase, beta 2-microglobulin (beta 2-m) and retinol-binding protein. Similar serum beta 2-m levels indicated no impairment of the glomerular filtration rate in the exposed workers. The levels of circulating immune complexes were also identical in both groups. The mean albuminuria was slightly higher (p less than .005) in the exposed group in a quantitative assay but was not dipstick-detectable. The mean urinary excretion of a renal antigen was also higher (p less than .05) in the exposed group and correlated with the excretion of albumin. Finally, slightly higher titers of anti-laminin antibodies were found in five exposed employees, but this was not accompanied by an increased albuminuria. We conclude that chronic low-level hydrocarbon exposure in these refinery workers does not lead to clinically significant renal abnormalities. Nevertheless, some findings are consistent with the possible role of hydrocarbon exposure in the induction of renal disturbances.


Asunto(s)
Industria Química , Hidrocarburos/efectos adversos , Enfermedades Renales/inducido químicamente , Enfermedades Profesionales/inducido químicamente , Adulto , Albuminuria/etiología , Antígenos/orina , Estudios Transversales , Humanos , Hidrocarburos/análisis , Riñón/inmunología , Enfermedades Renales/inmunología , Enfermedades Renales/orina , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/inmunología , Enfermedades Profesionales/orina , Petróleo
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