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. 2023 Jun;36(5):1401-1407.
doi: 10.1007/s40620-023-01606-y. Epub 2023 Apr 15.

Clinicopathological features and long-term prognosis of glomerular diseases associated with mercury-containing cosmetics

Lihua Zhang #  1 , Mengru Du #  2 , Yuanmao Tu  1 , Dandan Liang  1 , Xiaomei Wu  1 , Honglang Xie  3
Affiliations

Clinicopathological features and long-term prognosis of glomerular diseases associated with mercury-containing cosmetics

Lihua Zhang et al. J Nephrol. 2023 Jun.

Abstract

Objective: The pathological types and long-term prognosis of glomerular diseases related to mercury exposure are unclear. This study retrospectively examined 41 cases of glomerulonephropathy caused by mercury-containing cosmetics.

Methodology: Forty-one subjects with glomerular diseases presumably caused by mercury-containing cosmetics were selected. Clinical features, kidney biopsy, treatment, and follow-up data were collected.

Results: All patients were female with an average age of 39.4 ± 6.6 years at diagnosis. Median time of exposure to mercury-containing cosmetics was six months, and average urine mercury level was 66.80 ± 38.55ug/(g·Cr). Most patients presented with nephrotic syndrome. Renal histopathology showed membranous nephropathy in 22 patients (53.65%), minimal change disease in 13 patients (31.71%), IgA nephropathy with minimal change disease in 5 patients (12.20%), and focal segmental glomerulosclerosis in 1 patient. Median time of exposure to mercury was longer and the proportion of patients with autoantibodies (mainly antinuclear antibodies) was higher in patients with membranous nephropathy. Both blood phospholipase A2 receptor -Ab and kidney tissue phospholipase A2 receptor were negative. Thirty-six patients received glucocorticosteroids and/or immunosuppressants. Five patients were treated with an angiotensin receptor blocker, and nine patients were treated with chelation therapy. The median follow-up time was 40 months (range 27-94). All patients achieved complete remission, and the median time to complete remission was one month. They all successfully discontinued the drugs without relapsing; withdrawal time was 26 months.

Conclusion: Membranous nephropathy was the most common pathological type in mercury-induced glomerular disease. Patients were sensitive to glucocorticosteroids and immunosuppressants and achieved complete remission quickly. Contrary to primary glomerulonephritides, patients with mercury-induced glomerular diseases had no relapses after withdrawal of the mercury containing cosmetics.

Keywords: Mercury-containing cosmetics; Nephrotic syndrome; Prognosis; Renal pathology.

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