关键词: 急性肾损伤, 低分子右旋糖苷, 不良反应

Abstract:

ABSTRACT Objective: To investigate the clinical and pathological features of acute kidney injury (AKI) following infusion of low molecule dextran (dextran 40) in patients with nephrotic syndrome (NS). Methodology: From April, 2007 to June, 2014, twenty NS patients were diagnosed as AKI because of infusing dextran 40. Other causes of AKI including other drugs, septic shock, urinary obstruction and so on were excluded. Their clinical and pathological features and prognosis were investigated. Results：They were 17males and 3 females, with an average of 26.7±14.2 years .The course of NS was 4weeks（ranged from 3.00 to 9.50）. The primary glomerular disease of NS was MCD (45%), FSGS (35%), IgA nephropathy (10%), MN(5%) and IgM nephropathy (5%).Their initial serum creatinine (SCr) was 0.74±0.20mg/dl, and increased to 4.75±4.07（0.72～13.82）mg/dl after infusing with a usual dosage of Dextran 40 500ml/d（2~10d）for supplement blood volume. The duration of AKI was 4.00±2.25 weeks. Anemia was found in 60% of them, the quantity of proteinuria and urine sediment RBC were significantly increased after AKI（p<0.05）, with prominent renal tubular function injury and high proportion of glycosuria（55%）. The repeat renal biopsy was performed in 18 of them after AKI . Acute tubular necrosis (ATN) was diagnosed in 16 cases, and acute interstitial nephritis (AIN) in 2 cases. Vacuolation of the proximal tubular epithelium and brush border of lumen surface fell off were detected in 15 cases. Inflammatory cell infiltrations in interstitium were examined in 14 cases. Continuous renal replacement therapy was delivered to 10 cases. Prednisone was prescribed to the all cases. Complete remission was achieved in 20% of them and prednisone dependent in 25%. The levels of SCr were recovered to normal before discharging in 5 patients, and within one month in 10 patients. 3 patients were diagnosed as chronic kidney disease-stage 3, and 2 patients developed to ESRD one year after discharge. Conclusion: NS patient would suffer from AKI after administration of dextran 40, with poor prognosis in some of them. So the infusion of dextran 40 in patients with NS should be cautious.

Key words: acute kidney injury, dextran 40, nephrotic syndrome