Renal failure associated with low-molecular-weight dextran infusion.

Acute Renal Failure due to Mannitol Intoxication

“…Swelling and vacuolization of tubular cells (os motic nephrosis) with a substantial and reversible reduc tion in proximal tubular lumen diameter has been re ported in animals given large doses of mannitol [11]. These morphologic changes were similar to those de scribed in 3 cases of acute renal failure following dextran infusion where renal biopsies showed grossly swollen tubular cells obliterating the tubular lumen with substan tial accumulation of dextran in the tubular cells [12], These changes are, however, difficult to reconcile with the demonstrated role of mannitol in the prophylaxis of ischemic acute renal failure [13]. Moreover, in 1 case report where a renal biopsy was performed following mannitol infusion, changes of osmotic nephrosis were seen but there was no associated change in renal function [14].…”

Mannitol-Induced Acute Renal Failure

“…As mentioned previ ously, mannitol can induce histological alterations in the kidney, consisting of vacuolization of proximal and dis tal tubular cells ('osmotic nephrosis') and in certain in stances lead to substantial reductions in the luminal diameter as the result of cell swelling. In a number of experimental situations mannitol, glucose and dextran can be resorbed by pinocytosis leading to cell swelling and vacuolization [15,16] and reports exist which strongly implicate dextran in the genesis of acute renal failure [17].…”

Treatment of Shock with Dextrans and Gelatins

“…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].…”

“…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].…”

“…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.…”