SHM Converge Scientific Abstract ePoster Gallery-Edta Chelation and Nephrotic Syndrome

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This case describes a 77-year-old man with CKD stage IIIb, hypertension, treated hepatitis C, and a long history of welding exposure who developed sudden nephrotic syndrome after EDTA chelation for elevated heavy metals. He had no prior proteinuria on dipstick, but after his third EDTA infusion—given over 15 minutes instead of the usual 4–6 hours—he developed rapid generalized edema, a 13 kg weight gain, pleural/pericardial effusions, and hypertensive urgency.<br /><br />Workup showed marked proteinuria (UPCR 9.7 g/g), hypoalbuminemia, and worsening renal function. Heavy metal testing was significantly elevated, including cobalt, copper, manganese, niobium, tungsten, and zinc. Kidney biopsy revealed glomerular sclerosis, double-contour basement membranes, acute tubular necrosis, and medullary amyloid deposition. Congo red staining with apple-green birefringence confirmed amyloidosis, and mass spectrometry identified apolipoprotein A-IV (ApoA-IV) amyloidosis. Electron microscopy showed microtubular aggregates and podocyte foot process effacement.<br /><br />The patient improved with IV furosemide and steroids, then oral prednisone, with partial recovery of renal function.<br /><br />The authors propose a “second-hit” model: chronic heavy metal exposure may promote oxidative stress and ApoA-IV misfolding, leading to renal amyloid deposition, while EDTA infusion in a CKD patient may have unmasked or worsened underlying infiltrative kidney disease. They emphasize that occupational exposure history is often overlooked, that heavy metal toxicity can contribute to kidney injury, and that EDTA should be used with great caution in patients with CKD. Alternative chelators such as succimer or dimercaprol may be safer in such patients.

Asset Subtitle

Zahra Adnan

Meta Tag

Author List Ahmed Shah, Mansha Gupta, Zahra Adnan

Category Clinical Vignettes

Concept Heavy Metal Exposure

Concept Kidney Injury

Concept Renal Amyloidosis

Concept Apolipoprotein A-IV

Concept Amyloidosis

Distinguished Non-Finalist

Presenter Organization Midwestern University GME/Verde Valley Medical Center

Presenting Author Zahra Adnan

Track Adult

Keywords

nephrotic syndrome

EDTA chelation

heavy metal exposure

ApoA-IV amyloidosis

chronic kidney disease

proteinuria

occupational welding exposure

glomerular sclerosis

acute tubular necrosis

renal biopsy

Heavy Metal Exposure

Kidney Injury

Renal Amyloidosis

Apolipoprotein A-IV

Amyloidosis