A 47-year-old male who stopped smoking ten years ago smoked between 10-20 cigarettes/day for 15 years and was diagnosed with IgA eight years ago with mesangial glomerulonephritis.
He had been working for 12 years as a welder in a steel disk manufacturing company which had worn a pair of 'dives' of bad ovens' and 'tungsteno' for cutting.
The welder used an autogenous welding system, which used metal rods based on metal rods (39%), cadmium (25%), copper (22%) and zinc as input metal.
He consumed 1 kg/week; he did not use respiratory protection equipment and his workplace did not have a localized osmium extraction system.
Concentrations of cadmium in the workplace were 52 μg/m3 (Environmental cadheritis Level (ALV) is 10 μg/m3).
During the twelve years that he was working he had realized an initial recognition and two nonspecific periodic reviews without controlling the exposure to cadmium and other chemical contaminants; the results of the laboratory were within the study of liver glucose, serum cholesterol (transaminal).
A general blood test performed by your family doctor revealed microhematuria and proteinuria.
When your health care provider tells you about cadmium exposure, she is referred to our toxicology unit.
Upon admission, the patient is asymptomatic, has no personal or family history of nephrology, has no problems of obesity or diabetes (glycaemia are normal), does not take any type of medication in a usual way and blood pressure is 105 mm/H.
Laboratory tests revealed proteinuria of 2 g/24 h, microhematuria of 150 μg/field, blood cadmium of 20 μg/g (Valor en urine L/g), and urinary creatinine 5 μg/dl.
Because the renal affections were glomerular, and cadmium mainly causes tubular-type lesions, a study by renal biopsy was recommended.
Five glomeruli were observed in the optic disc, one of them fully sclerotic; the rest showed a slight segmental hypercellularity; in two glomeruli an interstitial tubular proliferation was detected.
Immunofluorescence was positive for C3 (++) and IgA (+) with mesangial pattern.
The diagnosis was focal glomerulonephritis Ig A mesangial and treatment with enalapril 10 mg/day was initiated.
Due to the high concentrations of cadmium in biological fluids (blood and urine), which after eight years of having ceased exposure are above the maximum permissible limit values in Spain we considered a worker with chronic exposure to cadmium to be especially sensitive.
The patient was followed up for 8 years (serum creatinine levels within normal GFR, proteinuria and sediment are shown in Table 1) and repeated controls of beta2-globulin and N-acetyl were found.
At present, cadmium concentrations in blood are 7 μg/l (VLB: 5 μg/l) and cadmium in urine is 18 μg/g (VLB: 5 μg/g).
