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Permanent renal failure induced by pentastarch.

Rahima Jamal1, Marc Ghannoum2, Jean-Francois Naud1

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High-volume hydroxyethyl starch (pentastarch) administration can cause acute kidney injury (AKI). Renal biopsy confirmed colloid-induced damage, highlighting risks, especially in patients with existing kidney dysfunction.

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Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Controversy surrounds fluid resuscitation with crystalloids versus colloids.
  • Renal dysfunction is a potential adverse effect of certain colloids and osmotic agents, though poorly characterized.

Purpose of the Study:

  • To report a case of acute kidney injury (AKI) following administration of a high volume of 10% pentastarch.

Main Methods:

  • Case report of a 67-year-old male with normal baseline kidney function.
  • Administration of over 10 liters of 10% pentastarch.
  • Renal biopsy to investigate the cause of anuric AKI.

Main Results:

  • The patient developed anuric acute renal failure (ARF).
  • Renal biopsy revealed hydropic changes in tubular cells, indicative of colloid-induced damage.
  • The observed tubular lesions may be persistent and irreversible.

Conclusions:

  • Hydroxyethyl starch (pentastarch) preparations are associated with acute kidney injury.
  • Careful consideration of hydroxyethyl starch use is warranted, particularly in patients with pre-existing renal impairment.
  • Colloid-induced osmotic tubular cell lesions can have long-lasting, irreversible consequences.