Grand Rounds: Nephrotoxicity in a Young Child Exposed to Uranium from Contaminated Well Water H. Sonali Magdo,1 Joel Forman,2,3 Nathan Graber,2,3 Brooke Newman,3 Kathryn Klein,2,3 Lisa Satlin,2 Robert W. Amler,4 Jonathan A. Winston,5 and Philip J. Landrigan2,3 1Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California, USA; 2Department of Pediatrics, and 3Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York, USA; 4School of Public Health, New York Medical College, New York, New York, USA; 5Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA Abstract Context: Private wells that tap groundwater are largely exempt from federal drinking-water regulations, and in most states well water is not subject to much of the mandatory testing required of public water systems. Families that rely on private wells are thus at risk of exposure to a variety of unmeasured contaminants. Case presentation: A family of seven—two adults and five children—residing in rural northwestern Connecticut discovered elevated concentrations of uranium in their drinking water, with levels measured at 866 and 1,160 µg/L, values well above the U.S. Environmental Protection Agency maximum contaminant level for uranium in public water supplies of 30 µg/L. The uranium was of natural origin, and the source of exposure was found to be a 500-foot well that tapped groundwater from the Brookfield Gneiss, a geologic formation known to contain uranium. Other nearby wells also had elevated uranium, arsenic, and radon levels, though concentrations varied widely. At least one 24-hr urine uranium level was elevated (> 1 µg/24 hr) in six of seven family members (range, 1.1–2.5 µg/24 hr) . To assess possible renal injury, we measured urinary beta-2-microglobulin. Levels were elevated (> 120 µg/L) in five of seven family members, but after correction for creatine excretion, the beta-2-microglobulin excretion rate remained elevated (> 40 µg/mmol creatinine) only in the youngest child, a 3-year-old with a corrected level of 90 µg/mmol creatinine. Three months after cessation of well water consumption, this child's corrected beta-2-microglobulin level had fallen to 52 µg/mmol creatinine. Significance: This case underscores the hazards of consuming groundwater from private wells. It documents the potential for significant residential exposure to naturally occurring uranium in well water. It highlights the special sensitivity of young children to residential environmental exposures, a reflection of the large amount of time they spend in their homes, the developmental immaturity of their kidneys and other organ systems, and the large volume of water they consume relative to body mass. Key words: beta-2-microglobulin, drinking water, drinking water standards, groundwater, nephrotoxicity, private wells, uranium. Environ Health Perspect 115:1237–1241 (2007) . doi:10.1289/ehp.9707 available via http://dx.doi.org/ [Online 22 May 2007] Address correspondence to P.J. Landrigan, Department of Community and Preventive Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1057, New York, NY 10029 USA. Telephone: (212) 241-4804. Fax: (212) 996-0407. E-mail: phil.landrigan@mssm.edu This work was supported by the Association of Occupational and Environmental Clinics/Agency for Toxic Substances and Disease Registry Pediatric Environmental Health Specialty Unit contract (U50/ATU300014-13) , and by the Mount Sinai Center for Children's Environmental Health and Disease Prevention Research supported by the U.S. Environmental Protection Agency (EPA-RD-83171101) and the National Institute of Environmental Health Sciences (ES009584) . The authors declare they have no competing financial interests. Received 11 September 2006 ; accepted 22 May 2007. The full version of this article is available for free in HTML or PDF formats. |