Dr Sawyer addresses three important issues concerning the diagnosis and treatment of lead nephropathy. First, he questions the extent and magnitude of the lead exposure in our patient. In the above-referenced report of the case, my colleagues and I stated that the patient had ingested moonshine whiskey in the remote past and had been employed in a lead smelting plant. Batuman et al1 had noted that many of their patients did not know the extent of their lead exposure or the amount of lead they had absorbed. None of their patients had overt lead intoxication at any time in the past. The strength of findings by Batuman and Wedeen2 are that the edetic acid (EDTA) lead mobilization test was significantly higher in those patients with renal disease and gout vs control populations with chronic renal failure alone or gout alone.
Second, Dr Sawyer questions the advisability of using
Germain MJ. Chelation Therapy in Lead Nephropathy Questioned-Reply. Arch Intern Med. 1985;145(10):1927. doi:10.1001/archinte.1985.00360100201041