title: Complication of oliguric acute renal failure in patients treated with low-molecular weight dextran.
abstract: Acute renal failure (ARF) is a well-documented but infrequent complication in patients treated with low-molecular weight dextran (LMWD). We herein report 3 cases of oliguric ARF following the administration of dextran-40. One case developed ARF totally after 1.200 g of LMWD administration. In contrast, two cases having increased serum creatinine developed oliguria despite the acceptable therapeutic doses (totally 450 and 650 g). Contrast media was also co-administered in these patients. Plasma exchange (PE), double filtration plasmapheresis (DFPP), or continuous hemodiafiltration (CHDF) but not hemodialysis (HD) reduced circulating dextran concentrations by 35-44% during a single session. All patients completely recovered from ARF by 14-32 days after the treatment. Our cases suggested that radiocontrast could predispose to the development of LMWD-induced ARF especially in patients having pre-existing renal dysfunction. In addition, PE, DFPP and CHDF afforded a beneficial effect for removing accumulated LMWD from the circulation.
authors.affiliation: First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan. akato@hama-med.ac.jp
authors.forename: A
authors.initials: A
authors.lastname: Kato
authors.forename: K
authors.initials: K
authors.lastname: Yonemura
authors.forename: H
authors.initials: H
authors.lastname: Matsushima
authors.forename: N
authors.initials: N
authors.lastname: Ikegaya
authors.forename: A
authors.initials: A
authors.lastname: Hishida
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D002544:Cerebral Infarction / Q000188:drug therapy; D003911:Dextrans / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D003639:Hearing Loss, Sudden / Q000188:drug therapy; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009846:Oliguria / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D000925:Anticoagulants; D003911:Dextrans