Water Science & Technology Vol 42 No 7-8 pp 147–154 © IWA Publishing 2000
Recent epidemiological studies on itai-itai disease as a chronic cadmium
poisoning in Japan
M Kasuya
Department of Public Health, Faculty of Medicine, Toyama Medical
and Pharmaceutical University, Sugitani 2630, Toyama 930-0194, Japan
ABSTRACT
Itai-itai disease is a chronic cadmium poisoning with renal tubular
dysfunction followed by osteomalacia. Renal tubular dysfunction among
inhabitants of the cadmium-polluted Jinzu River basin was irreversible
and progressive, despite the fact that cadmium exposure had decreased.
The bone mass was decreased in the inhabitants living in cadmium-polluted
areas with renal tubular dysfunction, correlating with the urinary
 2-microglobulin level. The decreased bone mass was diagnosed as
latent renal tubular osteomalacia. Low serum erythropoietin levels were
detected among the patients with itai-itai-disease, despite the presence
of severe anemia. The anemia found in the end-stage of the disease was
closely associated with an impaired renal function. Health surveys in
cadmium-polluted areas of 8 prefectures were carried out, and many cases
of renal tubular dysfunction were found in 4 prefectures, although the
most severe cases were found in Toyama Prefecture. Many cases whose
clinical features are completely in accord with those of itai-itai disease with severe renal tubular dysfunction and osteomalacia were
reported in 3 prefectures as well as Toyama Prefecture. Mortality risks
were increased in the patients with itai-itai disease, in the group
suspected of having the disease, and in the groups of mild renal tubular
dysfunction with 300–<1,000  g/g creatinine. The development
stage of the disease was divided into three stages. Those are the mild
stage (stage of cadmium nephropathy) with the renal tubular dysfunction
and decreased bone mass, the typical stage with the severe renal tubular
dysfunction and pseudofracture detectable by X-ray examination, and
the serious stage with severe renal dysfunction and pseudofracture and/or
fracture.
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