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Mannitol-induced acute renal failure

P Visweswaran1, E K Massin, T D Dubose

  • 1Department of Internal Medicine, University of Texas Medical School, Houston 77030, USA.

Journal of the American Society of Nephrology : JASN
|June 1, 1997
PubMed
Summary
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High-dose mannitol can cause acute kidney injury, particularly in renal transplant patients on cyclosporine. Stopping mannitol reversed the condition, highlighting the need for careful monitoring and risk assessment.

Area of Science:

  • Nephrology
  • Clinical Pharmacology

Background:

  • Mannitol is an osmotic diuretic used clinically for renal protection, reducing intracranial pressure, and preventing dialysis-disequilibrium syndrome.
  • It's frequently administered post-cardiac procedures and after contrast dye exposure.

Observation:

  • A case study details a renal transplant recipient on cyclosporine therapy who developed acute renal failure after high-dose mannitol administration.
  • Renal biopsy confirmed "osmotic nephrosis," a condition that resolved upon discontinuing mannitol.

Findings:

  • High-dose mannitol carries a nephrotoxic potential, especially in patients with pre-existing renal insufficiency.
  • While animal studies suggest cyclosporine A may enhance mannitol's tubular toxicity, this interaction is not definitively established in humans.

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Implications:

  • This case underscores the risk of mannitol-induced nephrotoxicity, even in transplant recipients.
  • The clinical utility of the osmolar gap in mitigating mannitol nephrotoxicity warrants emphasis for patient safety.