Saturnine gout

Chronic high-dose lead exposure, usually associated with months to years of blood lead concentrations in excess of 80 g/dL, may result in renal interstitial fibrosis and nephrosclerosis. Lead nephropathy may have a latency period of years. Lead may alter uric acid excretion by the kidney, resulting in recurrent bouts of gouty arthritis ("saturnine gout"). Acute high-dose lead exposure sometimes produces transient azotemia, possibly as a consequence of intrarenal vasoconstriction. 

In contrast to the reabsorptive defect of acute lead nephropathy, saturnine gout is characterized by renal retention of uric acid [18]. The clearance (Cp ) and maximal secretion rate (Tmp ) for p-aminohippurate (PAH) have been found to be variable in patients with occupational lead nephropathy. 

Lead miners Goslar, Germany Pb colic (a) Pb Gl tract toxicity constipation, epigastric pain, nausea, vomiting (b) Peripheral neuropathy, saturnine gout Stockhausen, 1656, Edsall (1907 Chapter 5)... 

Signs and symptoms noted by these ancient writers, when translated to current toxicological and epidemiological nomenclature, included central and peripheral nervous system (PNS) motor and sensory injury, manifest hemato-toxicity as frank anemia, severe gastrointestinal effects (earliest references to lead colic ), and in later centuries, saturnine gout attending lead nephrotoxicity. 

Nriagu, J.O., 1983b. Saturnine gout among Roman aristocrats did lead poisoning contribute to the fall of the Empire N. Engl. J. Med. 308, 660—663. 

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