Rock and Roll

A 50 year old man presents for followup for osteoporosis. You're surprised that he's so young and has advanced bone disease. In fact, he's had fractures and vertebral compression in the past. You decide to send some labs. His labs are even more surprising. He has proteinuria, renal glucosuria, aminoaciduria, renal phosphate wasting, and hypercalciuria. This is his first diagnosis of kidney disease, but he doesn't have hypertension, diabetes, vascular etiologies, obstructive nephropathy, or polycystic kidney disease. He has smoked two packs per day for thirty years. He has worked for the last twenty years at a facility that makes nickle-cadmium batteries, alloys, and galvanizing pigments.

The next day, you see one of his coworkers in the emergency department. Apparently, there was an explosion at the facility; the coworker wasn't injured by anything, but developed cough and dyspnea. His initial chest X ray is clear. You admit him to the hospital, but over the next few days, he develops a severe pneumonitis with hypoxia and respiratory failure. His X-ray is consistent with ARDS.

Challenge: What is the cause of both these presentations?

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