Chronic lead exposure can lead to kidney damage. This typically occurs after prolonged high-level exposure (> 5-year duration and levels > 60 mcg/dL) and is more common in patients with an underlying risk for chronic kidney disease (eg, hypertension, diabetes mellitus).

Clinical manifestations are related to chronicity of exposure.

• Acute exposure causes glucosuria, aminoaciduria, and renal phosphate wasting due to damage to the proximal tubules.
• Chronic exposure causes an elevated serum creatinine and hyperuricemia without significant proteinuria.

Consider lead nephropathy in patients presenting with chronic kidney disease, hypertension, and gout who also have a past or present exposure to lead.

Primary treatment is elimination of further lead exposure. Chelation therapy can be considered, but studies of its effectiveness in treating lead nephropathy are not definitive.