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Lead
- Usually industrial exposure, such as battery manufacturing plant.
- Symptoms:
- Hypertension
- Gout
- Chronic Kidney Disease (Chronic lead exposure in industry), often one of:
- Chronic tubulointerstitial nephritis causing proteinuria (with rare leukocytes and erythrocytes in urine sediment).
- Fanconi syndrome (glycosuria, normoglycemia, hyperuricemia, hypophosphotemia, aminoaciduria).
- Testing:
- Chelation mobilization testing.
- For long-term lead load and for previous lead exposure. (important in CKD etc..)
- 90% of total lead in bones (blood levels not adequate indicator)
- Technique: give chelating agent EDTA --> mobilizes lead deposited in tissues --> measure urine.
- Erythrocyte protoporphyrin levels
- For acute exposure. (useless for past exposure)
- Xrays of long bones
- In pediatrics (metaphysis of growing bones lights up)
- Blood smear
- Basophilic stripping of erythrocytes (also seen in megaloblastic anemia)
- Chelation mobilization testing.
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