Acute Renal Failure after Administration of Low-Molecular-Weight Dextran

Crystalloids or Colloids for the Treatment of Hypovolemia?

“…Analysis of most published case reports has revealed contributing factors such as age, repeated infusion of large quantities and arteritis 51 . Experimental models have enabled us to understand the pathophysiology of this type of kidney failure, which is an acute hyperoncotic syndrome.…”

Treatment of Shock with Dextrans and Gelatins

“…The tubular epithelium and the capillary coils of the glomeruli are compressed [93,118,128,129,211,221]. Alternatively, pro nounced degrees of 'osmotic nephrosis' may be present and cause tubular obstruction by the resulting cellular swelling [59,149].…”

“…The infusion of large amounts of low molecular dextran slows down the glomerular filtration rate [155]. Under standardized experimental conditions, the infusion of large doses of low molecular weight dextran combined with renal 'stress' in the form of hemorrhagic shock [85,127] extracorporeal perfusion [97,211] or unilateral renal artery stenosis [128,129] induce oliguric or anurie renal failure. Renal damage consecutive to experimental endotoxin shock may be ag gravated by low molecular weight dextran [222].…”

“…Mortality was close to 20% [7,13,21,48,96,118,128,129,149,156,157]. Reversible and irreversible cases of dextran damage may be encountered also in the absence of pre-existing dehydration or renal disease discernible by routine clinical methods [13,48,128,129,149].…”

“…If this regimen fails, it may be necessary to treat the patient once or peritoneal or counter the threat of renal damage due to low molecular weight dextran, preparations containing a fixed amount of mannitol have recently appeared on the European market. The resulting polyuria rapidly deprives the body of the fluid which the hyperoncotic colloid repeatedly by extracorporeal dialysis [7,48,59,128,129,149]. To has just withdrawn from the interstitial space.…”