Severe lead-induced peripheral neuropathy in a dialysis patient

Toxic neuropathy caused by lead (manifested as wrist drop) was a frequent p henomenon before 1925, In modern times, it is a distinct rarity, We report herein a Hispanic woman who developed end-stage renal failure, followed by wrist drop, in whom the maximal total blood lead was 69 mu g/dL. Measuremen ts of lead in her tibia and calcaneus by K-x-ray fluorescence, however, sho wed markedly elevated values, The wrist drop cleared after four treatments with intravenous calcium sodium edetate (Ca EDTA), In vitro studies of Pb-2 10 uptake by red blood cells (RBC) after incubation with normal or uremic p lasma indicated that Pb-210 uptake was inhibited by uremic plasma, These st udies suggest the presence of a transport inhibitor in uremia that modifies the distribution of lead between plasma and RBC, leading to lower overall blood values. (C) 2000 by the National Kidney Foundation, Inc.