Hydroxyethyl starch-induced renal insufficiency after plasma exchange in a patient with polymyositis and liver cirrhosis.
Hydroxyethyl starch (HES) is a macromolecular preparation that has been used as a volume expander since 1991. Renal toxicity of high-dose HES is now well recognized but potential renal toxicity of low-dose HES is poorly documented. Acute renal toxicity of cyclosporin A (CyA) may be responsible for osmotic nephrosis-like lesions. We report here the case of a 30-year-old male who developed cirrhosis due to hepatitis B and delta viruses and polymyositis. Polymyositis was treated with CyA, prednisone and plasma exchanges using low-dose HES as the replacement fluid. Renal insufficiency occurred with biopsy-proven osmotic nephrosis-like lesions, considered to be secondary to HES infusions and/or CyA.
Peron
S
S
Department of Internal Medicine, Hĵpital Avicenne and Assistance Publique Hĵpitaux de Paris, France.
Mouthon
L
L
Guettier
C
C
Brechignac
S
S
Cohen
P
P
Guillevin
L
L
D000328:Adult; D016572:Cyclosporine / Q000009:adverse effects; D006509:Hepatitis B / Q000150:complications; D003699:Hepatitis D / Q000150:complications; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D007668:Kidney / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000821:virology; D008297:Male; D010951:Plasma Exchange / Q000009:adverse effects*; D010952:Plasma Substitutes / Q000009:adverse effects*; D017285:Polymyositis / Q000150:complications / Q000628:therapy*; D051437:Renal Insufficiency / Q000139:chemically induced / Q000209:etiology* / Q000473:pathology
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D016572:Cyclosporine