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# Cadmium poisoning

Cadmium from tobacco, contaminated food or industry builds up in kidney and bone: it damages the tubule and weakens bones.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Kidneys](https://durgical.com/en/anatomy/kidney/)
- [Ribs (back part)](https://durgical.com/en/anatomy/ribs/)
- [L3 vertebra](https://durgical.com/en/anatomy/lumbar-vertebra-spine-and-pelvis-l3/)
- [Right upper lobe](https://durgical.com/en/anatomy/superior-lobe-of-right-lung/)
- [Left upper lobe](https://durgical.com/en/anatomy/superior-lobe-of-left-lung/)

## Why it happens

- [Heavy metals: lead, mercury, arsenic and cadmium](https://durgical.com/en/general-pathology/heavy-metals-lead-mercury-arsenic-and-cadmium/)

## What it is

Poisoning by cadmium, a heavy metal with no biological role that accumulates over decades, mainly in the kidney, bound to metallothionein.

## Who gets it

For non-smokers the main source is diet (grains, tubers, shellfish and organ meats from contaminated soils); tobacco doubles the body burden. Japan's itai-itai disease, from rice irrigated with mining water, is the historical example. In Latin America cadmium has been described in cocoa from some Andean soils, a monitoring issue for exporters, Colombia included.

## Causes

- Tobacco smoke
- Food grown in contaminated soils
- Work with nickel–cadmium batteries, electroplating, pigments, welding and zinc smelting
- Acute inhalation of cadmium oxide fumes when welding or cutting coated metal

## Risk factors

- Smoking
- Unprotected occupational exposure
- Iron deficiency (increases gut absorption)
- Multiparous women and older age

## Pathophysiology

Cadmium enters through transporters for essential metals (such as iron's DMT1) and in the [liver](https://durgical.com/en/anatomy/liver/) induces metallothionein, a cysteine-rich protein that traps it. The cadmium–metallothionein complex is filtered at the glomerulus and reabsorbed in the proximal tubule, where it releases the cadmium: it binds sulfhydryl groups, displaces zinc and calcium, causes oxidative stress and damages mitochondria. The result is a proximal tubulopathy (Fanconi syndrome): low-molecular-weight proteinuria (β2-microglobulin), glucosuria, aminoaciduria, phosphaturia and calcium loss. With phosphate and active vitamin D lacking (the damaged tubule makes less calcitriol) bone decalcifies: osteomalacia and osteoporosis with fractures. Inhaled, it causes acute chemical pneumonitis and, in the long term, emphysema and lung cancer (group 1 carcinogen).

## Classification

- Acute by inhalation (metal fume fever, pneumonitis)
- Acute by ingestion (gastroenteritis)
- Chronic (kidney, bone, lung)

## Symptoms and signs

- Cough, fever and breathlessness hours after inhaling fumes (acute)
- Nausea, vomiting and abdominal pain after swallowing salts (acute)
- Bone pain, especially lower back and legs (chronic)
- Fractures from minor trauma
- Kidney stones

## Red flags

- Progressive breathlessness after welding or cutting metal
- Tubular proteinuria in an exposed worker

## Diagnosis

**Clinical**
Occupational history, smoking and diet; suspected with proximal tubulopathy or unexplained fractures.

**Tests**
Urine cadmium (reflects body burden) and blood cadmium (recent exposure); urinary β2-microglobulin and other low-molecular-weight proteins; urine glucose, phosphate and calcium; [kidney](https://durgical.com/en/anatomy/kidney/) function.

**Imaging**
[Chest](https://durgical.com/en/anatomy/region/chest/) X-ray after acute inhalation; bone densitometry and X-rays for osteomalacia and fractures.

## Treatment

**Conservative**
Stopping exposure: quitting smoking and workplace protection measures.

**Acute**
Respiratory support in chemical pneumonitis from inhalation.

**Medical**
Calcium, vitamin D and phosphate according to the tubulopathy and bone status; chelation has no clear proven benefit and some chelators increase kidney damage.

**Follow-up**
Follow-up of tubular function, bone density and the lung.

## Complications

- Chronic kidney disease
- Osteomalacia, osteoporosis and fractures (itai-itai)
- Emphysema
- Lung cancer

## Prognosis

Cadmium stays in the kidney for decades: advanced tubular damage does not reverse even when exposure stops.

## Prevention

- Not smoking
- Control of cadmium in soils, fertilisers and food
- Ventilation and respiratory protection when welding

## Test yourself

Think of the answer, then tap the question to see it.

## Which protein traps cadmium and why does the kidney end up damaged?

Metallothionein; the complex is filtered, reabsorbed in the proximal tubule and releases the cadmium there.

## Which urine marker indicates cadmium tubular damage?

β2-microglobulin (low-molecular-weight proteinuria).

## Which historical bone disease is linked to cadmium?

Itai-itai: painful osteomalacia with fractures, in Japan, from contaminated rice.

## What is a smoker's main source of cadmium?

Tobacco smoke, which doubles the body burden compared with non-smokers.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/cadmium-poisoning/)

## Related conditions

- [Mercury poisoning](https://durgical.com/en/conditions/mercury-poisoning/)
- [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/)
- [Osteoporosis](https://durgical.com/en/conditions/osteoporosis/)
- [Rickets and osteomalacia](https://durgical.com/en/conditions/rickets-and-osteomalacia/)
- [Kidney stones (urolithiasis)](https://durgical.com/en/conditions/kidney-stones/)
- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Chronic obstructive pulmonary disease (COPD)](https://durgical.com/en/conditions/chronic-obstructive-pulmonary-disease/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Cadmium | ToxFAQs™ | ATSDR](https://wwwn.cdc.gov/TSP/ToxFAQs/ToxFAQsDetails.aspx?faqid=47&toxid=15) (Agency for Toxic Substances and Disease Registry (CDC), 2026); [Fanconi syndrome: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000333.htm) (MedlinePlus, US National Library of Medicine, 2026); Textbook of Biochemistry for Medical Students, 6th ed. (Jaypee Brothers Medical Publishers (Vasudevan DM, Sreekumari S, Vaidyanathan K), 2011).

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Source: https://durgical.com/en/conditions/cadmium-poisoning/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/cadmium-poisoning/