LETTER
Over-the-Counter Chromium and Renal Failure
Barry Mennen, MD
15 October 1997 | Volume 127 Issue 5 Part 1 | Pages 655-656
TO THE EDITOR:
Wasser and colleagues [1] suggest that trivalent chromium taken as a supplement for 6 weeks at 600 µg/d was responsible for a case of chronic active interstitial nephritis in a 49-year-old woman with hypertension. Although renal tubular damage has been described for such persons as welders of stainless steel, who are chronically exposed to water-soluble hexavalent chromium, there has never been a report of renal damage associated with dietary (trivalent) chromium in humans or animals [2] -even when animals received massive daily doses for 6 months [3]. In their review of chromium toxicity, Katz and Salem [2] conclude by stating "Clearly, considerations of chromium toxicity must differentiate between the various chromium species; speciation is a prerequisite to risk assessment."
Because the patient described by Wasser and colleagues had been treated with antihypertensive agents [1] (duration of this treatment and specific therapeutic agents used were not described), it is much more likely that her tubulointerstitial disease was attributable to one of these agents. For example, the sulfonamide diuretics as a group have a well-recognized etiologic role in acute interstitial nephritis [4].
I hope that the speculative conclusions of this case report will not distract clinicians from the facts: Chromium is an essential trace element required as a cofactor for insulin, and chromium insufficiency may be responsible for a substantial number of cases of impaired glucose tolerance [5].
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Author and Article Information
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Chromium Information Bureau, Inc.; New York, NY 10028
1. Wasser WG, Feldman NS, D'Agati VD. Chronic renal failure after ingestion of over-the-counter chromium picolinate [Letter]. Ann Intern Med. 1997; 126:410.
2. Katz SA, Salem H. The toxicology of chromium with respect to its chemical speciation: a review. J Appl Toxicol. 1993; 13:217-24.
3. Anderson RA, Bryden NA, Polansky MM. Lack of toxicity of chromium chloride and chromium picolinate. Toxicologist. 1996; 30:299.
4. McKinney TD. Tubulointerstitial diseases and toxic nephropathies. In: Bennett JC, Plum F, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia: WB Saunders; 1996:580-9.
5. Subcommittee on the Tenth Edition of the RDAs. Trace elements. In: Recommended Dietary Allowances. 10th ed. Washington, DC: National Academy Pr; 1989:241-3.
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