The combined effects of fluorine and arsenic on renal function in a Chinese population

Chronic exposure to combined fluoride and arsenic continues to be a major public health problem worldwide, affecting thousands of people. Although there have been reports in the literature about the toxicity of arsenic and fluoride individually, there is very little known about the combined effects of these two elements. The participates were selected from people living in fluoride–arsenic polluted areas due to burning coal. By observing the changes of renal function biomarkers, the results show that fluoride and arsenic can induce glomerular and tubular injury. For the observed exposure levels, the combined effect of fluoride and arsenic on renal function is mainly one of antagonism. Moreover, the benchmark dose and its lower confidence limit were calculated to estimate the exposure limits for urine arsenic (UAs) and urine fluoride (UF). The results indicate that the critical concentrations of UF and UAs for renal function injury were estimated, respectively, to be 0.54 mg g−1 Cr and 10.50 μg g−1 Cr in a population co-exposed to fluoride and arsenic; and urine albumin can be used as a relatively sensitive biomarker of renal function.