Lead nephropathy due to Sindoor in India

Abstract

We report a case of lead nephropathy due to Sindoor treated successfully with steroid, hemodialysis and chelating agent. Diagnosis of lead nephropathy was confirmed by identification of potential sources of lead exposure (Sindoor, 5-10 gm per year for 11 years) indicated by high blood lead level, 95 mg/dL and presence of extrarenal features of lead poisoning (hypertension, anemia, lead line, hyperuricemia). A search for the underlying systemic causes of renal failure yielded no results. A kidney biopsy showed acute or chronic tubule-interstitial nephritis with mesangioproliferative glomerulonephritis with no immune deposit on immunofluorescence consistent with lead nephropathy. He was discharged in good health after psychiatric consultation and continued with oral D-Penicillamine with normal renal function tests and urine output. This case identifies Sindoor as a potential lead exposure among Indians and clinicians should be aware of this risk factor and enquire about it when searching a source of lead exposure in high-risk population.

Related health hazards with occupational exposure to cadmium and lead during spray painting in car and furniture workshops

“…The author found interstitial nephritis and nephrosclerosis, suggesting a relation between elevated urate levels and nephropathy. This support that serum uric acid is a reliable biomarker of heavy metal exposure (Kute et al,2013). In parallel, the increased creatinine levels either in serum or urine along with increased urine proteins are certainly refer to disturbance in kidney function, as mentioned by Arora et al(2016).…”

Challenges in diagnosing lead poisoning: A review of occupationally and nonoccupationally exposed cases reported in India

“…Sindoor is a red powder used in cultural ceremonies and Hindu woman wear it on their forehead and hair to show the marital status, sometimes men and children wear it for religious purposes. A case of lead poisoning was reported by Kute et al (2013) in a 35-year-old man from Ahmedabad, Gujarat, India, showing symptoms of facial puffiness, constipation, nausea, vomiting, abdominal pain, anuria, irritability, excitability, and insomnia. It is reported that the patient used to ingest 5-10 g of Sindoor annually for religious purposes over a period of 11 years and the diagnosis revealed a thin bluish-gray line near the gums of the teeth, lead nephropathy, alteration in the function of kidney, and a BLL of 95.9 mg/dL.…”

Sources, blood concentrations, and approaches for reducing exposure to lead: A critical appraisal on lead poisoning

“…The occurrence of increased lead levels in various mediums necessitates rapid medical treatment. Traditional treatments have been linked to many recorded instances of lead poisoning in India (Kute et al 2013).…”