Reversible Nephrotoxic Reactions to a Combined 2,3-Dimercapto-1-propanol and Calcium Disodium Ethylenediaminetetraacetic Acid Regimen in Asymptomatic Children with Elevated Blood Lead Levels

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Abstract
One hundred thirty children aged 1 to 8 years with blood lead levels > 50 µg/100 ml of whole blood (WB) and free erythrocyte protoporphyrin (FEP) concentration > 250 µg/100 ml of WB received 207 chelation treatments for plumbism. All chelation treatments consisted of CaNa2 ethytenediaminetetraacetic acid (EDTA) 25 mg/kg per dose every 12 hours and 2,3-dimercapto-1-propanol (BAL) 3 mg/kg per dose every four hours for five days. Seventeen children demonstrated a transient doubling of pre-chelation treatment serum creatinine (≤ 2.0 mg/100 ml) during or following chelation treatment; 5/17 also had mild proteinuria. Four children developed severe oliguric (> 250 ml/sq m/day) acute renal failure. Serum creatinine levels were elevated six to seven days after chelation treatment was started and reached maximal values of 3.9 to 8.4 mg/100 ml, three to six days later. Renal function returned to pre-chelation treatment values during the subsequent six to 18 days. In the 21 nephrotoxic patients and the 109 nontoxic patients there were no significant differences in age (3.8 ± 0.6 vs 3.2 ± 0.2 years), sex (61% vs 53% males), percent who received multiple chelation treatments (38% vs 30%), blood lead levels (85 ± 5 vs 79 ± 1 µg/100 ml of WB), FEP (380 ± 30 vs 382 ± 18 µg/100 ml of WB), hemoglobin (11.5 ± 0.4 vs 11.1 ± 0.2 gm/100 ml, and pre-chelation treatment serum creatinine (0.46 ± 0.06 vs 0.58 ± 0.03 mg/100 ml). It was concluded that 13% of children with plumbism who received chelation treatments developed mild transient biochemical evidence of nephrotoxicity and another 3% developed acute renal failure characterized by oliguria four to eight days after chelation treatment was discontinued.

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