A case of acute renal failure due to hydroxyethyl starch

A 73-year-old nephrotic female developed acute renal failure (ARF) with serum creatinine to 586 umol/l after 4 days of therapy with hydroxyethyl starch (HES). Renal biopsy demonstrated that the histopathological appearance was mesangioproliferative glomerulonephritis with tubulointerstitial changes resembling acute tubulointerstitial nephritis. "Pulse" therapy with methylprednisolone, hemodialyses and other symptomatic treatment were performed in the patient during the oliguric phase of the disease. There was no worsening of her renal function, and subsequently it recovered fully. After 6 months of follow-up she had a serum creatinine of 112 umol/l, proteinuria had declined to 0.18 g/day and she is now doing well. Our findings suggest that an immune disease due to a hapten induced by HES may be a possible factor in the pathogenesis of ARF. Therefore, it is important for clinicians to bear in mind the possibility of ARF due to HES and it has been proposed that, whenever possible, HES should not be used in idiopathic nephritic syndrome patients to avoid severe complications.