Effects of Dextran 40 on Urine Flow and Composition during Renal Hypoperfusion in Dogs with Osmotic Nephrosis

Diomi, P; Ericsson, Jan L. E.; Matheson, N. A.

doi:10.1097/00000658-197011000-00006

Cited by 17 publications

(4 citation statements)

References 9 publications

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“…Legendre and colleagues have demonstrated osmotic nephrosis-like histological lesions in most transplanted kidneys after HES became the preferred plasma-volume expander for use in organ donors [ 50 ]. Similar histological lesions have been reported with other agents, including dextran, immunoglobulin, and mannitol [ 51 , 52 ]. This pathophysiology (including osmotic nephrosis) may also occur in patients treated with albumin.…”

Section: Introductionsupporting

confidence: 81%

Use or Misuse of Albumin in Critical Ill Patients

Saner¹,

Stüben

Hoyer

et al. 2023

Diseases

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Since 1940 albumin has been used worldwide and is widely available commercially since this time. However, a meta-analysis in 1998 challenged the use of albumin and identified a trend toward higher mortality in critically ill patients who had received albumin. Since then, many studies including multicenter randomized controlled trials have been carried out investigating the safety and efficacy of albumin treatment in different patient cohorts. In this context, patient cohorts that benefit from albumin were identified. However, particularly in non-liver patients, the use of albumin remains controversial. In our comprehensive review, we would like to highlight the most important studies in the recent 20 years and therefore offer an evidence-based outlook for the use of albumin for patients treated in the ICU.

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Section: Introductionsupporting

confidence: 81%

Use or Misuse of Albumin in Critical Ill Patients

Saner¹,

Stüben

Hoyer

et al. 2023

Diseases

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“…Since then, several hyperosmolar agents including intravenous immunoglobulins, mannitol, low‐molecular‐weight dextran, glucose, hydroxyethyl starches (HES; 6% HES [200/0.5], 6% HES [200/0.62]), and iodine‐containing contrast agents have been associated with the development of ON . It has been shown in both human and animal studies that several of these hyperosmolar agents enter renal proximal tubular cells via pinocytosis and fuse with each other and lysosomes, resulting in intracytoplasmic vacuolization and cytoplasmic swelling . The extent of vacuolization in ON depends on the quantity of agent administered, the rate of administration, the duration of intravenous infusion, and the digestibility of the agent by lysosomal enzymes …”

Section: Introductionmentioning

confidence: 99%

Postmortem evaluation of renal tubular vacuolization in critically ill dogs

Schmid

Cianciolo

Drobatz

et al. 2019

J Vet Emergen Crit Care

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Objective:To describe the frequency of renal tubular vacuolization (RTV) as a surrogate of osmotic nephrosis and assess hyperosmolar agents as predictors of RTV severity.Design: Retrospective study (February 2004-October 2014. Setting: Veterinary teaching hospital.Animals: Fifty-three client-owned, critically ill dogs that had a postmortem examination. Interventions: None.Measurements and Main Results: The frequency, severity, and location of RTV were determined in small group of critically ill dogs postmortem. Logistic regression was performed to assess cumulative 6% HES (670/0.75) and mannitol dose as predictors for RTV severity with presenting serum creatinine concentration, cumulative furosemide dose, and duration of hospitalization as covariates. RTV was noted in 45 (85%) of 53 critically ill dogs and was most commonly located to the medullary rays (68%). Cumulative 6% HES (670/0.75) dose (P = 0.009) and presenting serum creatinine concentration (P = 0.027) were significant predictors of RTV severity. For every 1 mL/kg increase in 6% HES (670/0.75) dose that a dog received, there was 1.6% increased chance of having more severe RTV (OR 1.016; 95% CI 1.004-1.029). In addition, for every 88.4 mol/L (1 mg/dL) increase in presenting serum creatinine, there was a 22.7% increased chance of having more severe RTV (OR 1.227; 95% CI 1.023-1.472). Cumulative mannitol (P = 0.548) and furosemide (P = 0.136) doses were not significant predictors of RTV severity. Conclusion:In a small group of critically ill dogs, there was a high frequency of RTV identified on postmortem examination. Administration of 6% HES (670/0.75) and presenting serum creatinine concentration were significant predictors of RTV severity. Larger prospective studies are needed to determine the etiology and significance of RTV in dogs. K E Y W O R D S canine, hydroxyethyl starch, osmotic nephrosis, vacuolization 1930s following intravenous administration of hypertonic sucrose in the treatment of increased intracranial pressure. 3 Since then, several hyperosmolar agents including intravenous immunoglobulins, mannitol, low-molecular-weight dextran, glucose, hydroxyethyl starches (HES; 6% HES [200/0.5], 6% HES [200/0.62]), and iodine-containing J Vet Emerg Crit Care. 2019;29:279-287. wileyonlinelibrary.com/journal/vec 279

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“…This is thought to be an effect of hyperchloremic metabolic acidosis and renal vasoconstriction. Mechanism of colloidinduced renal impairment include increased intraglomerular oncotic pressure with decreased glomerular filtration (15,16), induction of tubular backflow (17)(18)(19), and induction of intra-cellular colloid-conglomerates (20,21). Alterations in glomerular oncotic pressure probably plays a key role, since acute lowering of plasma oncotic pressure increases filtration fraction and sodium excretion (23).…”

Section: Introductionmentioning

confidence: 99%

Prevention of Acute Renal Failure - Fluid Repletion and Colloids

Scholbach

2004

Int J Artif Organs

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Hypovolemia alone or in conjunction with other factors is a main reason for acute renal failure in critically ill patients. Various crystalloid and colloid solutions are available to correct hypovolemia. Some of them have been implicated in impairment of renal function. Infusion of large amounts of sodium chloride is associated with increased incidence of nausea, vomiting and hyperchloremic metabolic acidosis. While gelatins and HES are preferred colloids in patients with normal kidney function, there is some evidence that the latter are associated with impaired renal function in patients with pre-existing kidney disease. Any hyperoncotic colloid given in large amounts may decrease glomerular filtration, and should therefore be combined with crystalloids.

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Effects of Dextran 40 on Urine Flow and Composition during Renal Hypoperfusion in Dogs with Osmotic Nephrosis

Cited by 17 publications

References 9 publications

Use or Misuse of Albumin in Critical Ill Patients

Use or Misuse of Albumin in Critical Ill Patients

Postmortem evaluation of renal tubular vacuolization in critically ill dogs

Prevention of Acute Renal Failure - Fluid Repletion and Colloids

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