The first report that lead can cause nephrotoxicity was by Lancereaux in 1863, who observed chronic kidney disease in an artist who habitually would hold paintbrushes in his mouth; there are some who believe that the collapse of the Roman empire was partially due to lead contamination of wine.
There are three ways in which lead may cause renal toxicity:
1. acute lead poisoning--a massive, acute lead exposure (which may occur in children who eat lead-based paint chips) can lead to Fanconi Syndrome and acute kidney injury, along with other symptoms such as colic, encephalopathy, and anemia.
2. chronic lead poisoning--chronic exposure to lead--as might occur with an occupational exposure for instance--is characterized by a chronic interstitial nephritis, and is often associated with hypertension and gout. Gout is actually quite rare in other forms of CKD, so the appearance of gout and CKD together should prompt screening for serum lead levels.
3. lead-induced hypertension--lead can lead to renal disease indirectly by causing hypertension--a finding which has been confirmed in numerous epidemiologic studies.