Acute renal failure following massive mannitol infusion and enalapril treatment.
We report a patient with reversible acute oligoanuric renal failure. Intravenous mannitol 25% was infused to treat intracranial edema, during chronic administration of ACE inhibitors for arterial hypertension. Serum creatinine level rose to 5.6 mg/dl from a previous value of 1.2 mg/dl. Measured and calculated serum osmolalities were 310 and 280 mosm/kg respectively. We postulate that the association of afferent arteriolar constriction due to mannitol induced tubulo-glomerular imbalance and efferent dilatation due to ACE inhibitors provoked a sharp reduction in glomerular filtration rate. Alternatively, mannitol infusion may have caused tubular cell swelling with luminal obstruction.
Nakhoul
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Rambam Hospital, Dept. of Nephrology, Haifa, Israel.
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D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D004234:Diuretics, Osmotic / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008353:Mannitol / Q000009:adverse effects*; D008875:Middle Aged
D000806:Angiotensin-Converting Enzyme Inhibitors; D004234:Diuretics, Osmotic; D008353:Mannitol; D004656:Enalapril