Cadmium is said to be an important cause of chronic kidney disease of uncertain aetiology in Sri Lanka. It would be very beneficial that if there is a non invasive screening tool to detect cadmium induced early renal damage.
Associations of proteinuria with low-level urinary cadmium (Cd) are currently interpreted as the sign of renal dysfunction induced by Cd. There are many uncertainties.
Well, cadmium tends to precipitate in the proximal convluted tubules where it can acumulate at this site and cause tubular toxicity and chronic interstitial fibrosis or even fanconi syndrome
source of contamination could be food , smoking or occupational exposure
early diagnosis: in high risk population by checking:
KIM-1 which can be detected in urine and precede the occurrence of proteinuria by 5-6 weeks can be a useful marker for , in addition to that beta 2 micro-globulin in urine, urinary retinol binding protein and NAGL level combined with cadmium level in urine can provide early diagnosis
proteinuria and fanconi syndrome indicate established cadmium toxicity
Vitamin E protects against oxidative damage generated by cadmium in epithelial and endothelial tight junctions of the nephron
http://www.smb.org.mx/smb-anterior/XXVIICONGRESO/Text/AREA-9/CARTELES/9_B_3.pdf
This may help: http://www.futuremedicine.com/doi/abs/10.2217/bmm.13.51
Prof Nick Buckley, one of the authors, has been investigating acute kidney injury in Sri Lanka with Mohammed Fahim using various injury biomarkers. If you message me, I can provide Fahim's contacts.
I think that protein of low MW like alpha1microglobulin would be an early test of renal damage but it is a very sensitive test and therefore not specific; some are orientated towards new test as KIM-1 but this test is more expansive
In heavy metals chronic kidney injury, tubular markers are classically the earliest predictors of future renal impairement which will take years to occur. Enzymuria, beta2microglulin and alpha1microglobulin have been studied in this setting.
From a practical point of view, actuallly alpha1microglobulin is to be preferred.
Kind regards
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