Clinical Information

Cadmium toxicity resembles that of the other heavy metals, including arsenic, mercury, and lead. The kidney is the primary organ affected Kidney dysfunction with proteinuria and slow onset (over a period of years) is the typical presentation. Measurable changes in proximal tubule function, such as decreased clearance of para-aminohippuric acid, also develop over several years and precede overt kidney failure.

Inhalation of cadmium vapor can cause nasal epithelial deterioration and pulmonary congestion resembling chronic emphysema.

For nonsmokers, food is the primary source of cadmium exposure. In general, leafy vegetables such as lettuce and spinach, potatoes, grains, peanuts, soybeans, and sunflower seeds contain high levels of cadmium. For smokers, tobacco smoke is the most common source of exposure is and has been implicated as the primary source of cadmium associated with reproductive toxicity in both men and women.

Chronic cadmium exposure can cause cumulative kidney damage. Cadmium excretion is proportional to creatinine unless kidney damage is present. Cadmium-induced kidney damage may be detected by increased cadmium excretion relative to creatinine.

For Occupational Safety and Health Administration-mandated workplace exposure monitoring (Fed Reg 57:42,102-142,463, September 1992), measurement of urine cadmium and creatinine should be ordered and results reported as mcg of cadmium per gram of creatinine.