Prevention of acute renal failure: An experimental study and a preliminary clinical report

To simulate a clinical situation, fifty-three dogs were transfused with incompatible human blood after induction of hemorrhagic shock. Of the ten animals which received no therapy, five died and in two of the five survivors marked acute renal failure developed.Infusion of low molecular weight dextran (LMDX) prevented death, respiratory distress and acute renal failure in the sixteen animals similarly treated. The commercial dextran, normal saline and 5 per cent dextrose solution did not prove effective under similar conditions in twenty-seven dogs. Four of these died and in four of the twenty-three survivors severe acute renal failure developed.In another set of thirty experiments, transfusion of heterologous blood in normal dogs was well tolerated by the majority of animals without any apparent acute renal failure. A second transfusion, however, resulted in severe anaphylactoid reaction and profound shock resulting in death in six of nine animals and acute renal failure in one of the three survivors.Here again prophylactic use of LMDX showed a definite protective effect against severe anaphylactoid shock and prevented renal failure, as supported by hemodynamic and histologic data. THAM and mannitol used similarly did not provide appreciable protection.Based on these observations, LMDX was used prophylactically in seventy-six high risk patients under clinical settings which usually result in acute renal failure. In none of these patients did acute renal failure develop nor did the patients show any complications attributed to the use of LMDX.It may be concluded that acute renal failure is a preventable disease and that further clinical experience with low molecular weight dextran is justifiably indicated.