Osmotic nephrosis

In a report of two cases of anuric acute renal insufficiency induced by dextran 40, diuresis and renal function were quickly restored to normal after plasmapheresis (12). Renal biopsy showed normal kidneys, except for swelling and vacuolation of renal tubules suggestive of osmotic nephrosis. 

During surgery for an avulsed pinna, an 18-year-old Chinese man was given 500 ml of 10% dextran 40 infused over 2 hours at 12-hourly iutervals (18). Ou day 3 he developed uausea aud abdominal pain. The dextran infusion was stopped. His serum creatiuiue was 1092 pmol/1. Total auuria followed within 24 hours aud he developed acute pulmouary edema. Renal biopsy was compatible with osmotic nephrosis caused by dextran. 

Two cases of osmotic nephrosis-hke lesions have been reported in which similar changes have been noted, accompanied by evidence of renal insufficiency. The first case occurred after the administration of etherified starch during surgery (26). 

Legendre C, Xhervet E, Page B, Percheron A, Noel LH, Kreis H. Hydroxyethylstarch and osmotic-nephrosis-like lesions in kidney transplantation. Lancet 1993 342(8865) 248-9. 

Bfhalil M, Shin HJ, Tan A, DuBose TD Jr, Ordonez N, Katz RL. Macrophage hke vacuolated renal tubular cells in the urine of a male with osmotic nephrosis associated with intravenous immunoglobulin therapy. A case report. Acta Cytol 2000 44(1) 86-90. 

Osmotic nephrosis When the proximal tubules are exposed to hyper osmotic, non-reabsorbable solutes such as mannitol, osmotic nephrosis can lead to AKI. [69]. More recently the use of hy-droxyethylstarch for resuscitation of hypotensive patients has been associated with increased incidence of AKI [70] The addition of sugar excipients to Intravenous immunoglobulin s, while reducing the constitutional symptoms associated with their administration have increased in the risk of acute kidney injury [71]. 

Osmotic nephrosis Mannitol, immune globulin, dextrans, hetastarch Urine sediment shows vacuole containing cells... 

Acute kidney injury may be due to tissue parenchymal injury as manifested by direct tubule toxicity, acute interstitial nephritis, osmotic nephrosis and thrombotic microangiopathy. 

Moreau JF, Droz D, Sabto J, Jungers P, Kleinknecht D, Flinglais N, Michel JR. Osmotic nephrosis induced by water soluble triiodin-ated contrast media in man. Radiology 1975 115 329-336. 

Triamterene has been reported to cause photosensitivity reactions, increase in uric acid concentration, and blood dyscrasias.91 Nephrolithiasis may occur in susceptible patients. Megaloblastic anemia has been reported in patients with depleted folic acid stores such as those with hepatic cirrhosis. In a study conducted on rats, daily treatment of the animals with doses of 1.5, 3 and 4.5 mg/lOOg over the period of three weeks caused severe degenerative changes of renal cortical and medullary tubules resembling osmotic nephrosis.93 Reversible acute renal failure from combined triamterene and indomethacin in healthy subjects is reported.94 It is recommended that this potentially nephrotoxic association be avoided. 

Osmotic nephrosis Mannitol Dextran Intravenous immunoglobulin... 

In patients with severe burns, HES 200/ 0.5 was associated with an increased risk of renal insufficiency and mortality compared with crystalloids only, but these findings were not statistically significant renal biopsies showed osmotic nephrosis-like lesions [38 ]. 

Moreau, J., Droz, D., Sabto, J. et al. (1975) Osmotic nephrosis induced by water-soluble tri-iodinated contrast media in man. A retrospective study of 47 cases. Radiology, 115, 329. 

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