{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T11:03:24Z","timestamp":1787828604105,"version":"build-2784847793"},"reference-count":69,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T00:00:00Z","timestamp":1618444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010034","name":"Walailak University","doi-asserted-by":"publisher","award":["The P2P Project"],"award-info":[{"award-number":["The P2P Project"]}],"id":[{"id":"10.13039\/501100010034","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: The adult population in lead-related occupations or environmentally exposed to lead may be at risk for renal impairment and lead nephropathy. This meta-analysis aims to determine the impact of blood lead level (BLL) on renal function among middle-aged participants. Methods: Cross-sectional, longitudinal, or cohort studies that reported BLL and renal function tests among adult participants were retrieved from PubMed, Scopus, and ISI Web of Science. Relevant studies were included and assessed for quality using the Newcastle\u2013Ottawa Scale (NOS). The pooled mean BLL of participants with a high BLL (\u226530 \u00b5g\/dL), moderate BLL (20\u201330 \u00b5g\/dL), and low BLL (&lt;20 \u00b5g\/dL) was estimated using the random effects model. The pooled mean differences in BLL, blood urea nitrogen (BUN), creatinine, uric acid, and creatinine clearance between the exposed and non-exposed participants were estimated using the random effects model. Meta-regression was performed to demonstrate the association between the effect size (ES) of the pooled mean BLL and renal function. Heterogeneity among the included studies was assessed using the Cochrane Q and I2 statistics. Cochrane Q with a p value less than 0.05 and I2 more than 50% demonstrated substantial heterogeneity among the studies included. Publication bias was assessed using the funnel plot between the effect size and standard error of the effect size. Results: Out of 1657 articles, 43 were included in the meta-analysis. The meta-analysis demonstrated that the pooled mean BLL in the participants with a high BLL, moderate BLL, and low BLL was 42.41 \u00b5g\/dL (95% confidence interval (CI): 42.14\u201342.67, I2: 99.1%), 22.18 \u00b5g\/dL (95% CI: 21.68\u201322.68, I2: 60.4%), and 2.9 \u00b5g\/dL (95% CI: 2.9\u20132.9, I2: 100%), respectively. The mean BLL of the exposed participants was higher than that of the non-exposed participants (weighted mean difference (WMD): 25.5, p &lt; 0.0001, 95% CI: 18.59\u201332.45, I2: 99.8%, 17 studies). The mean BUN (WMD: 1.66, p &lt; 0.0001, 95% CI: 0.76\u20132.55, I2: 76%, 10 studies) and mean creatinine (WMD: 0.05, p = 0.007, 95% CI: 0.01\u20130.08, I2: 76.8%, 15 studies) in the exposed participants were higher than those in the non-exposed participants. The mean creatinine clearance in the exposed participants was lower than that in the non-exposed participants (standard mean difference (SMD): \u22120.544, p = 0.03, 95% CI: \u22121.035\u2013(\u22120.054), I2: 96.2%). The meta-regression demonstrated a significant positive effect of BLL on BUN (p = 0.022, coefficient: 0.75, constant: \u22123.7, 10 studies). Conclusions: BLL was observed to be associated with abnormal renal function test parameters, including high BUN, high creatinine, and low creatinine clearance. Moreover, BUN seemed to be the most valuable prognostic marker for lead-induced renal impairment. Therefore, regular checks for renal function among lead-exposed workers should be a priority and publicly promoted.<\/jats:p>","DOI":"10.3390\/ijerph18084174","type":"journal-article","created":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T12:11:00Z","timestamp":1618488660000},"page":"4174","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Blood Lead Level and Renal Impairment among Adults: A Meta-Analysis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0631-9058","authenticated-orcid":false,"given":"Saruda","family":"Kuraeiad","sequence":"first","affiliation":[{"name":"Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat 80160, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manas","family":"Kotepui","sequence":"additional","affiliation":[{"name":"Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat 80160, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1515\/intox-2015-0009","article-title":"Lead toxicity: A review","volume":"8","author":"Wani","year":"2015","journal-title":"Interdiscip. Toxicol."},{"key":"ref_2","first-page":"527","article-title":"Estimation of Benchmark Dose for Bone Damage and Renal Dysfunction in a Chinese Male Population Occupationally Exposed to Lead","volume":"52","author":"Sun","year":"2008","journal-title":"Ann. Occup. Hyg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1053\/j.ajkd.2018.02.358","article-title":"Blood Lead Levels and Decreased Kidney Function in a Population-Based Cohort","volume":"72","author":"Harari","year":"2018","journal-title":"Am. J. Kidney Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1111\/bcpt.13179","article-title":"Impact of chronic lead exposure on liver and kidney function and haematologic parameters","volume":"124","author":"Nakhaee","year":"2019","journal-title":"Basic Clin. Pharmacol. Toxicol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.amjmed.2016.05.042","article-title":"Continual Decrease in Blood Lead Level in Americans: United States National Health Nutrition and Examination Survey 1999\u20132014","volume":"129","author":"Tsoi","year":"2016","journal-title":"Am. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Yimthiang, S., Waeyang, D., and Kuraeiad, S. (2019). Screening for Elevated Blood Lead Levels and Related Risk Factors among Thai Children Residing in a Fishing Community. Toxics, 7.","DOI":"10.3390\/toxics7040054"},{"key":"ref_7","first-page":"31","article-title":"Elevated blood lead level alters the liver and kidney function tests of spray painters","volume":"12","year":"2020","journal-title":"Pravara. Med. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.scitotenv.2019.03.052","article-title":"Blood lead levels and cognitive functioning: A meta-analysis","volume":"668","author":"Vlasak","year":"2019","journal-title":"Sci. Total Environ."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1289\/ehp.908961","article-title":"Current issues in the epidemiology and toxicology of occupational exposure to lead","volume":"89","author":"Landrigan","year":"1990","journal-title":"Environ. Health Perspect."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.envres.2008.09.005","article-title":"Longitudinal associations between lead dose and renal function in lead workers","volume":"109","author":"Weaver","year":"2009","journal-title":"Environ. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.scitotenv.2008.04.004","article-title":"Renal dysfunction and hyperuricemia with low blood lead levels and ethnicity in community-based study","volume":"401","author":"Lai","year":"2008","journal-title":"Sci. Total Environ."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1093\/ndt\/9.6.613","article-title":"Changed excretion of urinary proteins and enzymes by chronic exposure to lead","volume":"9","author":"Pergande","year":"1994","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1136\/oem.55.7.453","article-title":"Lead absorption and renal dysfunction in a South African battery factory","volume":"55","author":"Ehrlich","year":"1998","journal-title":"Occup. Environ. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1289\/ehp.7317","article-title":"Associations among Lead Dose Biomarkers, Uric Acid, and Renal Function in Korean Lead Workers","volume":"113","author":"Weaver","year":"2005","journal-title":"Environ. Health Perspect."},{"key":"ref_15","first-page":"182","article-title":"Association of lead exposure, serum uric acid and parameters of renal function in Nigerian lead-exposed workers","volume":"1","author":"Alasia","year":"2010","journal-title":"Int. J. Occup. Environ. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1159\/000167519","article-title":"Renal dysfunction in brazilian lead workers","volume":"7","author":"Rocha","year":"1987","journal-title":"Am. J. Nephrol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1177\/0748233710390020","article-title":"Assessment of some renal indices in people occupationally exposed to lead","volume":"27","author":"Onuegbu","year":"2010","journal-title":"Toxicol. Ind. Health"},{"key":"ref_18","unstructured":"Gounden, V., Bhatt, H., and Jialal, I. (2021). Renal Function Tests. StatPearls, EDN."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s00420-002-0362-0","article-title":"Relationship between blood lead levels and renal function in lead battery workers","volume":"75","author":"Wang","year":"2002","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1136\/oem.51.8.505","article-title":"Renal function and hyperfiltration capacity in lead smelter workers with high bone lead","volume":"51","author":"Roels","year":"1994","journal-title":"Occup. Environ. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Azami, M., Tardeh, Z., Mansouri, A., Soleymani, A., and Sayehmiri, K. (2018). Mean Blood Lead Level in Iranian Workers: A Systematic and Meta-Analysis. Iran. Red Crescent Med. J., 20.","DOI":"10.5812\/ircmj.64172"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_23","unstructured":"(2021, January 15). International Prospective Register of Systematic Reviews. Available online: https:\/\/www.crd.york.ac.uk\/prospero\/."},{"key":"ref_24","unstructured":"(2021, January 20). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. Available online: http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"ref_25","first-page":"112","article-title":"Renal dysfunction in workers exposed to inorganic lead","volume":"30","author":"Lim","year":"2001","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Hozo, S.P., Djulbegovic, B., and Hozo, I. (2005). Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res. Methodol., 5.","DOI":"10.1186\/1471-2288-5-13"},{"key":"ref_27","unstructured":"(2021, January 25). The Standard for Clinical Calculations & Quantitative Analysis in Medicine. Available online: http:\/\/www.scymed.com\/."},{"key":"ref_28","unstructured":"Higgins, J.P.T., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2021). Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, Wiley."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.ijheh.2016.01.005","article-title":"Urinary and blood cadmium and lead and kidney function: NHANES 2007\u20132012","volume":"219","author":"Buser","year":"2016","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.ecoenv.2019.01.121","article-title":"The association between lead and cadmium co-exposure and renal dysfunction","volume":"173","author":"Chen","year":"2019","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1007\/s10157-014-0959-0","article-title":"Erratum to: Blood lead and cadmium levels and renal function in Korean adults","volume":"18","author":"Chung","year":"2014","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"21","DOI":"10.3390\/ijerph2004010021","article-title":"Liver and Renal Function Tests in Artisans Occupationally Exposed to Lead in Mechanic Village in Nnewi, Nigeria","volume":"1","author":"Dioka","year":"2004","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/BF00625951","article-title":"Assessment of thyroid, testes, kidney and autonomic nervous system function in lead-exposed workers","volume":"64","author":"Gennart","year":"1992","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/S0969-8043(97)00094-8","article-title":"In vivo XRF as a means to evaluate the risk of kidney effects in lead and cadmium exposed smelter workers","volume":"49","author":"Gerhardsson","year":"1998","journal-title":"Appl. Radiat. Isot."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1136\/oem.49.3.186","article-title":"Kidney effects in long term exposed lead smelter workers","volume":"49","author":"Gerhardsson","year":"1992","journal-title":"Occup. Environ. Med."},{"key":"ref_36","first-page":"395","article-title":"Renal function in lead exposed urban population","volume":"20","author":"Goswami","year":"2001","journal-title":"Poll. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.envres.2005.03.004","article-title":"Lead blood concentrations and renal function evaluation: Study in an exposed Mexican population","volume":"100","author":"Fortoul","year":"2006","journal-title":"Environ. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jtemb.2019.03.007","article-title":"Lead and kidney: Concentrations, variabilities, and associations across the various stages of glomerular function","volume":"54","author":"Jain","year":"2019","journal-title":"J. Trace Elements Med. Biol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1539\/joh.40.103","article-title":"Renal Dysfunction Indicators in Lead Exposed Workers","volume":"40","author":"Jung","year":"1998","journal-title":"J. Occup. Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1001\/jama.1996.03530390043032","article-title":"A longitudinal study of low-level lead exposure and impairment of renal function. The Normative Aging Study","volume":"275","author":"Kim","year":"1996","journal-title":"JAMA"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Kshirsagar, M.S., Patil, A.J., and Patil, J. (2019). Impact of Occupational Lead Exposure on Liver and Kidney Function Tests on Silver Jewellery Workers. J. Clin. Diagn. Res., 13.","DOI":"10.7860\/JCDR\/2019\/38084.12442"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1002\/tox.20260","article-title":"Benchmark dose approach for renal dysfunction in workers exposed to lead","volume":"22","author":"Lin","year":"2007","journal-title":"Environ. Toxicol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1159\/000368496","article-title":"Continuous Lead Exposure Increases Blood Pressure but Does Not Alter Kidney Function in Adults 20-44 Years of Age in a Lead-Polluted Region of China","volume":"40","author":"Jialun","year":"2015","journal-title":"Kidney Blood Press. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1093\/ndt\/gfy279","article-title":"Renal function in relation to low-level environmental lead exposure","volume":"34","author":"Mujaj","year":"2018","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1046\/j.1523-1755.2003.00812.x","article-title":"Blood lead and chronic kidney disease in the general United States population: Results from NHANES III","volume":"63","author":"Muntner","year":"2003","journal-title":"Kidney Int."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1093\/aje\/kwp248","article-title":"Blood Cadmium and Lead and Chronic Kidney Disease in US Adults: A Joint Analysis","volume":"170","author":"Guallar","year":"2009","journal-title":"Am. J. Epidemiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s00204-004-0597-5","article-title":"Renal effects and erythrocyte oxidative stress in long-term low-level lead-exposed adolescent workers in auto repair workshops","volume":"78","author":"Oktem","year":"2004","journal-title":"Arch. Toxicol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"77","DOI":"10.2486\/indhealth.28.77","article-title":"No adverse effects of lead on renal function in lead-exposed workers","volume":"28","author":"Omae","year":"1990","journal-title":"Ind. Health"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1515\/JBCPP.2007.18.2.87","article-title":"Occupational lead exposure in battery manufacturing workers, silver jewelry workers, and spray painters in western Maharashtra (India): Effect on liver and kidney function","volume":"18","author":"Patil","year":"2007","journal-title":"J. Basic Clin. Physiol. Pharmacol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1093\/oxfordjournals.aje.a117330","article-title":"Low-level Lead Exposure and Renal Function in the Normative Aging Study","volume":"140","author":"Payton","year":"1994","journal-title":"Am. J. Epidemiol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Reilly, R., Spalding, S., Walsh, B., Wainer, J., Pickens, S., Royster, M., Villanacci, J., and Little, B.B. (2018). Chronic Environmental and Occupational Lead Exposure and Kidney Function among African Americans: Dallas Lead Project II. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15122875"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1289\/ehp.7192","article-title":"Evidence for Concurrent Effects of Exposure to Environmental Cadmium and Lead on Hepatic CYP2A6 Phenotype and Renal Function Biomarkers in Nonsmokers","volume":"112","author":"Satarug","year":"2004","journal-title":"Environ. Health Perspect."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1136\/oem.47.7.442","article-title":"Blood lead concentration, renal function, and blood pressure in London civil servants","volume":"47","author":"Staessen","year":"1990","journal-title":"Occup. Environ. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1056\/NEJM199207163270303","article-title":"Impairment of Renal Function with Increasing Blood Lead Concentrations in the General Population","volume":"327","author":"Staessen","year":"1992","journal-title":"N. Engl. J. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1289\/ehp.7024","article-title":"Lead, Diabetes, Hypertension, and Renal Function: The Normative Aging Study","volume":"112","author":"Tsaih","year":"2004","journal-title":"Environ. Health Perspect."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1002\/ajim.4700120402","article-title":"Influence of occupational low-level lead exposure on renal parameters","volume":"12","author":"Verschoor","year":"1987","journal-title":"Am. J. Ind. Med."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Wang, X., Liang, H., Wang, Y., Cai, C., Li, J., Li, X., Wang, M., Chen, M., Xu, X., and Tan, H. (2018). Risk factors of renal dysfunction and their interaction in level-low lead exposure paint workers. BMC Public Health, 18.","DOI":"10.1186\/s12889-018-5475-9"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1136\/oem.2010.056077","article-title":"Associations of low-level urine cadmium with kidney function in lead workers","volume":"68","author":"Weaver","year":"2010","journal-title":"Occup. Environ. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1136\/oem.60.8.551","article-title":"Associations of lead biomarkers with renal function in Korean lead workers","volume":"60","author":"Weaver","year":"2003","journal-title":"Occup. Environ. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1097\/01.jom.0000155971.10111.6d","article-title":"Associations of Patella Lead and Other Lead Biomarkers With Renal Function in Lead Workers","volume":"47","author":"Weaver","year":"2005","journal-title":"J. Occup. Environ. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"407","DOI":"10.4314\/njm.v19i4.61965","article-title":"Occupational and Environmental Lead Exposure in Port Harcourt, Nigeria: Analysis of its association with renal function indices","volume":"19","author":"Alasia","year":"2010","journal-title":"Niger. J. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/S0048-9697(01)00762-8","article-title":"A longitudinal study of the effects of long-term exposure to lead among lead battery factory workers in Taiwan (1989\u20131999)","volume":"279","author":"Hsiao","year":"2001","journal-title":"Sci. Total Environ."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.envint.2010.11.012","article-title":"Blood lead levels in the adult population living in France the French Nutrition and Health Survey (ENNS 2006\u20132007)","volume":"37","author":"Falq","year":"2011","journal-title":"Environ. Int."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.fct.2013.03.024","article-title":"Lead, mercury, and cadmium in blood and their relation to diet among Swedish adults","volume":"57","author":"Bjermo","year":"2013","journal-title":"Food Chem. Toxicol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1002\/jat.2550100402","article-title":"Urinary N-acetyl-beta-d-glucosaminidase activity in lead-exposed workers","volume":"10","author":"Endo","year":"1990","journal-title":"J. Appl. Toxicol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1136\/bmj.1.6059.482","article-title":"Renal insufficiency associated with excessive lead exposure","volume":"1","author":"Campbell","year":"1977","journal-title":"BMJ"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ijcard.2015.08.109","article-title":"Regulation of uric acid metabolism and excretion","volume":"213","author":"Maiuolo","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1289\/ehp.97105928","article-title":"Renal effects of environmental and occupational lead exposure","volume":"105","year":"1997","journal-title":"Environ. Health Perspect."},{"key":"ref_69","unstructured":"(2021, February 01). Lead, Available online: https:\/\/www.osha.gov\/lead\/health-effects."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/8\/4174\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:48:16Z","timestamp":1760161696000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/8\/4174"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,15]]},"references-count":69,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["ijerph18084174"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18084174","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,15]]}}}