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[Hydroxyethyl starch-induced transient renal failure in preexisting glomerular damage]
P Waldhausen1, H Kiesewetter, G Leipnitz
1Abteilung für Klinische Hämostaseologie und Transfusionsmedizin, Universitätskliniken des Saarlandes, Homburg/Saar, BRD.
Acta Medica Austriaca
|January 1, 1991
Summary
Hydroxyethyl starch (HES) hemodilution therapy can worsen existing kidney disease. Ensuring adequate fluid intake and careful patient selection are crucial to prevent renal complications during HES treatment.
Area of Science:
- Nephrology
- Internal Medicine
- Pharmacology
Background:
- Hemorheological therapy using hemodilution is increasingly used in clinical settings.
- Dextrans are known to cause renal insufficiency, but HES-induced nephropathy has not been previously reported.
Observation:
- Two cases are presented where patients with pre-existing nephropathy experienced acute kidney injury during stationary hemodilution therapy with HES.
- The study observed a potential link between HES administration and the deterioration of renal function in susceptible individuals.
Findings:
- HES molecules may increase glomerular basal lamina permeability, leading to increased primary urine viscosity.
- Adequate fluid intake (around 3 liters/day) can help avoid renal insufficiency.
- Careful patient selection is needed for hemodilution therapy, especially in patients with creatinine >1.5 mg/dL and hypertension.
Implications:
- Patients undergoing HES hemodilution require careful monitoring of renal function, with retention parameters checked every other day.
- Sufficient hydration is essential during HES therapy to mitigate nephrotoxic effects.
- Gelatin preparations may be a safer alternative for hemodilution in certain patients due to their lack of cumulation.