Overview
Chronic mercury nephropathy results from prolonged exposure to elemental mercury, leading to systemic toxicity affecting multiple organs, particularly the kidneys, nervous system, and musculoskeletal system 1.Diagnosis
Unexplained extremity pain, especially in pediatric patients, should raise suspicion for mercury intoxication 1.
Laboratory tests may reveal tubulopathy and neuropathy 1.
Urinary mercury levels or chelation challenge tests can confirm exposure 1.
Neurological and renal function assessments are crucial for evaluating organ-specific damage 1.Management
First-line treatment: Dimercaptosuccinic acid (DMSA) and other chelating agents like metalcaptase 1.
Adjunctive measures: Supportive care addressing specific organ dysfunction (e.g., antihypertensive therapy for hypertension) 1.Special Populations
Pediatrics: Chronic mercury exposure can manifest with severe extremity pain and acrodynia; early diagnosis is critical 1.
Comorbidities: Hypertension and neuropathy are noted comorbidities requiring specific management 1.Key Recommendations
Consider elemental mercury intoxication in pediatric patients presenting with unexplained extremity pain and neurological symptoms (Evidence: Weak 1).
Prompt initiation of chelation therapy with agents like Dimercaptosuccinic acid is recommended for confirmed cases of mercury intoxication (Evidence: Weak 1).
Regular monitoring of renal and neurological functions is essential in managing chronic mercury nephropathy to prevent severe morbidity (Evidence: Expert opinion 1).References
1 Kısaarslan AP, Sözeri B, Baştuğ F, Gündüz Z, Yel S, Nalçacıoğlu H et al.. Elemental mercury intoxication in 7 patients admitted to a pediatric rheumatology clinic. The Turkish journal of pediatrics 2019. link