DOI 10.5414/CN107383

Clinical Nephrology, Volume 79 - April (326 - 334)

Minimal change disease caused by exposure to mercury-containing skin lightening cream: a report of 4 cases

Hon-Lok Tang1, Yuen-Fun Mak2, Kwok-Hong Chu1, William Lee1, Samuel Ka‑Shun Fung1, Thomas Yan-Keung Chan3, Kwok-Lung Tong1
1 Division of Nephrology, Department of Medicine, Geriatrics, 2 Department of Pathology, Princess Margaret Hospital, 3 Department of Medicine, Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China

Abstract

Mercury is a known cause of nephrotic syndrome and the underlying renal pathology in most of the reported cases was membranous nephropathy. We describe here 4 cases of minimal change disease following exposure to mercury-containing skin lightening cream for 2 – 6 months. The mercury content of the facial creams was very high (7,420 – 30,000 parts per million). All patients were female and presented with nephrotic syndrome and heavy proteinuria (8.35 – 20.69 g/d). The blood and urine mercury levels were 26 – 129 nmol/l and 316 – 2,521 nmol/d, respectively. Renal biopsy revealed minimal change disease (MCD) in all patients. The use of cosmetic cream was stopped and chelation therapy with D-penicillamine was given. Two patients were also given steroids. The time for blood mercury level to normalize was 1 – 7 months, whereas it took longer for urine mercury level to normalize (9 – 16 months). All patients had complete remission of proteinuria and the time to normalization of proteinuria was 1 – 9 months. Mercury-containing skin lightening cream is hazardous because skin absorption of mercury can cause minimal change disease. The public should be warned of the danger of using such products. In patients presenting with nephrotic syndrome, a detailed history should be taken, including the use of skin lightening cream. With regard to renal pathology, apart from membranous nephropathy, minimal change disease should be included as another pathological entity caused by mercury exposure or intoxication.

Author Details

Authors

  • Hon-Lok Tang1
  • Yuen-Fun Mak2
  • Kwok-Hong Chu1
  • William Lee1
  • Samuel Ka‑Shun Fung1
  • Thomas Yan-Keung Chan3
  • Kwok-Lung Tong1

Departments

  • 1 Division of Nephrology, Department of Medicine, Geriatrics,
  • 2 Department of Pathology, Princess Margaret Hospital,
  • 3 Department of Medicine, Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China

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