Mercury-associated glomerulonephritis: a retrospective study of 35 cases in a single Chinese center

Abstract

Background Long-term exposure of mercury may induce glomerulonephritis. Clinical and pathological features of mercury-associated glomerulonephritis are not fully clear. This study retrospectively analyzed 35 cases of mercury-associated glomerulonephritis in a single Chinese center. Methods Thirty-five patients of mercury-associated glomerulonephritis were enrolled. Clinical data on diagnosis and during follow-up were collected. Plasma anti-phospholipase A2 receptor (PLA2R) antibody, glomerular PLA2R and glomerular IgG subclasses deposition were detected in the cases with membranous nephropathy (MN). Results Mercury exposure was caused by skin lighting cream (20 patients), mercury-containing pills (9 patients), hair-dyeing agents (4 patients), and unidentified reasons (2 patients). All patients presented with proteinuria and normal renal function. The median of urinary protein was 4.6 (range 1.6~19.7) g/24 h. Twenty-two patients (62.9%) had nephrotic syndrome. Renal histopathology showed minimal change disease (MCD) in 21 patients (60.0%), MN in 13 (37.1%) and focal segmental glomerular sclerosis (FSGS) in 1 patient (2.9%). The proportion of MCD increased along with urinary mercury concentration ( P = 0.024). In 13 cases of MN, all patients were negative for plasma anti-PLA2R antibody and glomerular PLA2R antigen. IgG1 (61.5%) and IgG4 (46.2%) deposits were noted along the glomerular capillary loops. Among the 16 patients received mercury detoxification monotherapy, 14 patients received 4.5 ± 2.8 (range 1~12) rounds of regimen and achieved complete remission in 4.5 (range 0.3~23.0) months, 2 patients stayed no remission. Conclusions MCD was the most common pathological type of mercury-associated glomerulonephritis, followed by MN. The proportion of MCD increased along with the increase of urinary mercury concentration. Most patients could achieve complete remission after mercury detoxification.

Membranous Nephropathy Associated With Indigenous Indian Medications Containing Heavy Metals

“…They also observed that in patients who received glucocorticoids or immunosuppression. 8 In our series, patients who received steroids had obtained an early remission despite having relatively higher urine and serum mercury levels. Mercury may persist in tissues despite normal serum and urine mercury levels.…”

“…reported their experience with combined immunosuppression and chelation with sodium dimercaptopropane sulfonate. 8 Those patients who received glucocorticoids and immunosuppression, along with chelation, had lower sodium dimercaptopropane sulfonate requirements. The median duration of remission with combined therapy was 2.5 months versus 4.5 months in patients who received chelation alone.…”

“…This might account for failure to achieve remission after chelation, and such patients might need immunosuppressive agents. 8 Despite not receiving chelation, all patients eventually headed for a remission. Patient 3 did not recover renal function despite the reduction in proteinuria.…”

“…This might account for failure to achieve remission after chelation, and such patients might need immunosuppressive agents. 8 …”

Heavy Metals: The Notorious Daredevils of Daily Personal Care Products- Mini Review

“…Significant level of As and Hg was reported with Mohammad et al, 2017 in skin bleaching agents of Caribbean region [50] As used in skin cream and make-up powder causes skin problems, lung cancer, circulatory and peripheral neuropathy, and increased risk of gastrointestinal and urinary tract malignancies [51,52]. Several recent and older studies reported nephrotic syndrome from repeated exposure of mercury and other heavy metals from skin lightening agent [53][54][55][56][57][58]. Dental amalgam has been used as a restorative treatment in dentistry for well over 170 years.…”