Environmental injury to the kidney: Interstitial nephritis

SummaryThe First Emperor of China (Qin Shi Huang: 259–210 BCE) would have been interested in interstitial nephritis. He might conceivably be fascinated to know that consumption of mercury elixir, instead of giving him immortality, might have shortened his life by giving him interstitial nephritis. In the Balkan region of Eastern Europe, clustering of a peculiar interstitial nephritis is prevalent. One environmental risk contributing to Balkan endemic nephritis is aristolochic acid contamination of cooking flour, drinking water, and herbal medicine. In addition, the popular use of nonprescription Chinese weight reduction herbs and public unawareness of the consequential aristolochic acid nephropathy has become a worldwide problem. Finally, the mighty Romans of antiquity lost their empire, arguably due to lead in their wine containers, lead water pipes, and lead cooking utensils. In modern times, lead paint has become universally banned, which has resulted in a reduction of lead-induced interstitial nephritis. In recent decades, bisphenol A (BPA) has been identified as a new environmental risk. BPA is in the plastic coating of food and beverage containers to prevent corrosion. BPA is so ubiquitous that urinary BPA and proteinuria are present in a high percentage of the population. BPA-induced kidney injury and other health concerns have led certain countries to ban BPA. Now, BPA-free containers are being introduced with great fanfare by manufacturers, but safety issues on all plastic products remain. It begs the question whether “plastics” of today take the place of “lead” in ancient Rome. This is a challenging question without an answer at this point.

中國的首任皇帝 (秦始皇：259BCE–210BCE) 應該會對以下事實感到有興趣—他眼中的長生不老丹藥 (含水銀)，原來會導致間質性腎炎，令他反而會折壽。另外，在東歐的巴爾幹地區，一種獨有的間質性腎炎頗為盛行，此種「巴爾幹流行性腎炎」歸因於環境性因素—馬兜鈴酸 (aristolochic acid) 污染了食用麵粉、飲用水、及草藥。事實上，基於大眾對馬兜鈴酸腎病變缺乏認識，非處方中草藥 (減重用) 的普遍使用已導致了全球性的健康問題。有人甚至指出，羅馬帝國的覆亡，可能與鉛中毒有關 (酒容器、水管、煮食用具中普遍含鉛)。近代，含鉛顏料已全面被禁止，減少了鉛所導致間質性腎炎的發生。在最近數十年，bisphenol A (BPA) 被發現為一種新的環境性危害，它存在於食物與飲料容器上的塑料塗層，用於預防腐蝕，其廣泛使用導致人口中有高比例出現尿液含 BPA 及蛋白尿現象。基於與 BPA 有關的腎臟傷害及其他健康問題，BPA 已被某些國家禁止使用。目前，有生產商正致力推廣不含 BPA 的容器，但塑膠製品的安全性問題仍然存在。現代塑料的危害是否類似古羅馬時代的鉛，實在是一個值得令人深思的課題。