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The serum copper-to-zinc ratio (CZR) was used as an essential metal imbalance indicator. We divided the subjects into two Cd exposure groups based on the reference level of urinary\u00a0Cd for renal dysfunction (2\u00a0\u03bcg\/g creatinine).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The geometric mean concentration of urinary Cd in all subjects was 2.25\u00a0\u03bcg\/g creatinine. In both low and high Cd exposure groups, urinary Cd levels were positively correlated with urinary NAG activity, but not with serum CZR. After multivariate adjustment, serum CZR was strongly associated with urinary \u03b22-MG levels in the low Cd exposure group (<jats:italic>\u03b2<\/jats:italic>\u2009=\u20091.360, <jats:italic>P<\/jats:italic>\u2009=\u20090.019) and was significantly associated with urinary MDA levels, regardless of Cd exposure level. In addition, the risk of renal tubular damage was significantly associated with urinary Cd level, particularly in the lowest or highest CZR tertile groups.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Essential metal imbalance may be a determinant of oxidative stress and renal tubular damage in a chronically Cd-exposed population, and proper zinc supplementation will be effective in preventing adverse health effects due to Cd exposure.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00420-019-01490-9","type":"journal-article","created":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T17:02:45Z","timestamp":1573837365000},"page":"337-344","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Copper\u2013zinc imbalance induces kidney tubule damage and oxidative stress in a population exposed to chronic environmental cadmium"],"prefix":"10.1007","volume":"93","author":[{"given":"Sang-Yong","family":"Eom","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Hyuk","family":"Yim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingai","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choong-Hee","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guen-Bae","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Do","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung-Sun","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Duck","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4671-8045","authenticated-orcid":false,"given":"Yong-Dae","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,11,15]]},"reference":[{"issue":"1","key":"1490_CR1","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/S1570-0232(02)00273-8","volume":"775","author":"R Agarwal","year":"2002","unstructured":"Agarwal R, Chase SD (2002) Rapid, fluorimetric-liquid chromatographic determination of malondialdehyde in biological samples. 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