Disease/Syndrome

Acute tubular necrosis

Category

Acute Poisoning

Acute/Chronic

Acute-Severe

Synonyms

Renal failure with acute tubular necrosis

Comments

Lead was a common cause of acute tubular necrosis (ATN) and chronic renal failure in the past. "Under conditions of extremely high respiratory exposure to lead, an acute encephalopathy can develop, accompanied by renal failure and severe GI symptoms." [Sullivan, p. 282, 881] Adolescents inhaling leaded gasoline (alkyl lead) had renal and hepatic damage. [Nordberg, p. 956] Welding cadmium plated steel in an enclosed space could expose the worker to high enough concentrations of cadmium to develop ATN. [LaDou, p. 416] Ingestion of mercury salts can cause acute renal failure, but occupational exposure to mercury fume generally causes injury to the lungs and CNS not to the kidneys. Uranium causes ATN in high-dose animal studies, and cases of ATN were reported in the past. Chronic kidney disease caused by uranium has not been reported. [Rosenstock, p. 565-84] "Renal failure may be caused by a direct nephrotoxic action of the poison or acute massive tubular precipitation of myoglobin (rhabdomyolysis), hemoglobin (hemolysis), or calcium oxalate crystals (ethylene glycol), or it may be secondary to shock caused by blood fluid loss or cardiovascular collapse." [Olson, p. 38]

Latency/Incubation

Hours to days; [LaDou, p. 416]

Diagnostic

Urinalysis: renal tubular cells; granular casts; no significant protein, red cells, or white cells; Progressive rise in serum creatinine and BUN; [LaDou, p. 416]

ICD-9 Code

584.5

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