Chronic Lead Nephropathy Saturnine Gout — ESENeph MCQ

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HardChronic Kidney DiseaseChronic Lead Nephropathy Saturnine GoutESENeph

A 72-year-old man presents with progressive CKD (eGFR decline 8 mL/min/1.73m2 per year). He has a history of gout, hypertension, and chronic lead exposure from industrial work 30 years ago. Urinalysis shows minimal proteinuria. Ultrasound shows small echogenic kidneys. Blood lead level is now within normal limits. What historical exposure is most likely responsible for his CKD pattern?

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Correct answer: B — Chronic lead nephropathy

Chronic lead nephropathy (saturnine nephropathy) is a slowly progressive tubulointerstitial nephropathy caused by cumulative lead exposure. Classic features include: slowly progressive CKD with minimal proteinuria, hyperuricaemia/gout (lead inhibits uric acid excretion), hypertension, and small echogenic kidneys. Blood lead levels may be NORMAL at the time of diagnosis because lead redistributes from blood to bone over years — the total body burden remains high despite low circulating levels. EDTA mobilisation testing or X-ray fluorescence of bone can assess cumulative exposure. Treatment is supportive (CKD management) as chelation does not reverse established fibrosis. The gout-hypertension-CKD triad with occupational lead exposure is the diagnostic constellation.

Reference: Ekong et al 2006 – Lead Nephrotoxicity; JRCPTB 2022 – Nephrology Curriculum