| Tubular and Glomerular Kidney Effects in Swedish Women with Low Environmental Cadmium Exposure Agneta Åkesson,1 Thomas Lundh,2 Marie Vahter,1 Per Bjellerup,3 Jonas Lidfeldt,4 Christina Nerbrand,5 Göran Samsioe,6 Ulf Strömberg,2 and Staffan Skerfving2 1Institute of Environmental Medicine, Division of Metals and Health, Karolinska Institutet, Stockholm, Sweden; 2Department of Occupational and Environmental Medicine, University Hospital, Lund, Sweden; 3Department of Clinical Chemistry, Karolinska University Hospital, Huddinge, Sweden; 4Department of Community Health, Malmö University Hospital, Malmö, Sweden; 5Department of Medicine, and 6Department of Gynecology and Obstetrics, University Hospital, Lund, Sweden Abstract
Cadmium is a well-known nephrotoxic agent in food and tobacco, but the exposure level that is critical for kidney effects in the general population is not defined. Within a population-based women's health survey in southern Sweden (Women's Health in the Lund Area, WHILA) , we investigated cadmium exposure in relation to tubular and glomerular function, from 1999 through early 2000 in 820 women (71% participation rate) 53-64 years of age. Multiple linear regression showed cadmium in blood (median, 0.38 µg/L) and urine (0.52 µg/L ; density adjusted = 0.67 µg/g creatinine) to be significantly associated with effects on renal tubules (as indicated by increased levels of human complex-forming protein and N-acetyl-β-d-glucosaminidase in urine) , after adjusting for age, body mass index, blood lead, diabetes, hypertension, and regular use of nephrotoxic drugs. The associations remained significant even at the low exposure in women who had never smoked. We also found associations with markers of glomerular effects: glomerular filtration rate and creatinine clearance. Significant effects were seen already at a mean urinary cadmium level of 0.6 µg/L (0.8 µg/g creatinine) . Cadmium potentiated diabetes-induced effects on kidney. In conclusion, tubular renal effects occurred at lower cadmium levels than previously demonstrated, and more important, glomerular effects were also observed. Although the effects were small, they may represent early signs of adverse effects, affecting large segments of the population. Subjects with diabetes seem to be at increased risk. Key words: cadmium, diabetes, environmental exposure, glomerular effects, hypertension, kidney, lead, population-based, tubular effects, women. Environ Health Perspect 113: 1627-1631 (2005) . doi:10.1289/ehp.8033 available via http://dx.doi.org/ [Online 11 July 2005]
Address correspondence to A. Åkesson, Institute of Environmental Medicine, Division of Metals and Health, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden. Telephone: 46-8-524-875-42. Fax: 46-8-33-70-39. E-mail: Agneta.Akesson@imm.ki.se The late A. Schütz made invaluable contributions to the study. We thank H. Ottosson, A. Akantis, A.-M. Åberg, and B. Erdling for skillful technical assistance. Funding was provided by the Swedish Research Council/Medicine ; Medical Faculty of Lund University ; Karolinska Institutet ; the National Swedish Environmental Protection Agency ; the Swedish Foundation for Strategic and Environmental Research ; the Swedish Society of Medicine, Primary Care, R&D, County Council of Skåne ; the Swedish Research Council for Environment, Agricultural Sciences, and Spatial Planning ; and the Swedish Council for Working Life and Social Research. The authors declare they have no competing financial interests. Received 21 February 2005 ; accepted 11 July 2005.
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