Environmental Toxins

Exposure to environmental toxins may not increase the risk of DN per se, but may well accelerate its progression by adding to the burden of interstitial kidney disease (59). Transitional and disadvantaged populations may experience high levels of toxic exposure at work, because access to types of employment in which such exposures are less may be limited by language and educational attainment. Those who live and work in rural environments may be exposed more frequently to nephrotoxins used in industrial agriculture including fertilizers, herbicides, and insecticides containing heavy metals like arsenic. Urban workers may be exposed to hydrocarbons and heavy metals used in manufacturing, including cadmium, mercury, and lead.

Toxic exposures may also occur at home. As recent immigrants to cities, members of transitional and disadvantaged populations may be less likely to own land or have influence over land use and more likely to live in neighborhoods where they are exposed to toxic chemicals at unhealthy levels. Cultural practices that arise in response to economic forces and social disruption may also lead to toxic exposures that harm the kidney. Moonshine, for example, is an alcoholic beverage made cheaply by distilling ethanol in radiators typically lined with lead and using copper pipe soldered with lead. Drinking moonshine distilled in such containers may result in lead nephropathy, which could hasten progression of DN as well (60).

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