Lead poisoning is an increasingly important public health issue. In children the central nervous system is the most severely affected with cognitive and neurobehav-ioural impairment, but lead can affect a variety of organ systems. In kidneys it can cause tubular dysfunction that generally depends on the extent and duration of exposure. However, even low values can cause nephropathy with progressive increased in serum creatinine and elevated risk of CKD in adulthood, especially if the lead exposure occurs over a prolonged period. The paper reports the case of an 8-year-old boy from Venezuela who developed a hyperchloremic metabolic acidosis. He was diagnosed with acute tubulointerstitial nephritis from heavy metal intoxication (blood lead 5.3 µg/dl). After 3 months of chelation therapy and 6 months of alkalinization therapy blood tests have showed a normalization of blood lead levels and acid-base balance with complete regression of signs of acute tubular dysfunction.