Dextran removal by plasmapheresis in a kidney-pancreas transplant recipient with dextran 40-induced osmotic nephrosis.
Osmotic nephrosis with acute kidney injury can follow the administration of colloid volume expanders and other hypertonic solutions. In the kidney transplant setting, such agents may be used in the donor before organ procurement and in the recipient during the perioperative period. We report a case of acute lung and kidney injury after infusion of dextran 40 immediately after surgery in a kidney-pancreas transplant recipient. Osmotic nephrosis was confirmed by kidney biopsy, and a spectrophotometric assay was used to measure dextran 40 levels in serial serum samples. Plasmapheresis was initiated to decrease dextran 40 levels. Post hoc analysis confirmed that a single session of apheresis was sufficient to rapidly decrease dextran 40 levels without rebound, consistent with a small volume of distribution in a single-compartment model.
Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA.
Aash P
AP
Bhatt
Vishala T
VT
Neppalli
Elizabeth A
EA
Kelley
Annette J
AJ
Schlueter
Christie P
CP
Thomas
D001706:Biopsy; D002908:Chronic Disease; D003911:Dextrans / Q000009:adverse effects* / Q000097:blood; D003920:Diabetes Mellitus / Q000601:surgery; D006801:Humans; D006982:Hypertonic Solutions; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009401:Nephrosis / Q000139:chemically induced* / Q000628:therapy*; D009995:Osmosis; D016035:Pancreas Transplantation / Q000379:methods*; D010952:Plasma Substitutes / Q000009:adverse effects*; D010956:Plasmapheresis / Q000379:methods*; D016896:Treatment Outcome
D003911:Dextrans; D006982:Hypertonic Solutions; D010952:Plasma Substitutes