Reemergence of sucrose nephropathy: acute renal failure caused by high-dose intravenous immune globulin therapy

Sucrose nephropathy was first described more than 50 years ago. The disorder is characterized by acute renal failure caused by the uptake of sucrose by renal proximal tubule cells with subsequent cellular swelling and occlusion of the tubule lumen. Approximately 114 cases of renal failure have been associated with high-dose intravenous immune globulin (IVIG) therapy. Almost all cases were caused by preparations containing large amounts of sucrose. Clinicians should consider using IVIG preparations containing no sucrose in patients who are at high risk for renal failure. Risk factors include older age, baseline renal failure, and volume contraction.     

Acute renal failure after large doses of intravenous immune globulin.

OBJECTIVE: To describe a case of acute renal failure after high-dose intravenous immune globulin (IVIG) therapy and the measures undertaken to prevent this complication during subsequent administration. CASE SUMMARY: A 54-year-old white man with valvular cardiomyopathy was receiving large doses (2 g/kg/mo) of IVIG in order to attenuate his immune system in preparation for a heart transplant. After his first infusion, he had to be rehospitalized for nausea, vomiting, fever, chills, and acute renal failure (serum creatinine [Scr] peak 8.4 mg/dL, baseline 1.0 mg/dL). His second infusion produced similar complications. Sandoglobulin 100 mL/h (172 g; 10% solution prepared with sterile water) was used on both occasions, and the large sucrose load (1.67 g sucrose/g protein) was suspected to be the causative agent. Upon switching to Polygam (170 g; 10% solution prepared with sterile water), a glucose-containing product which only has 0.4 g glucose/g protein, and infusing it at half of the Sandoglobulin rate (50 mL/h), the patient was able to tolerate the infusion without complications (Scr and blood urea nitrogen unchanged). DISCUSSION: Stabilizing agents such as sucrose, maltose, and glucose are added to IVIG preparations to help reduce immunoglobulin aggregation. These aggregates are associated with some of the more serious adverse effects of IVIG administration. When large doses of IVIG are used, the stabilizing agents can induce an osmotic nephrosis due to the large solute load. A review of the previous literature on IVIG-induced renal failure is provided, as well as the differences in the various IVIG formulations. Also, general guidelines are offered to prevent this complication. CONCLUSIONS: Large doses of Sandoglobulin (400-2000 mg/kg) have been associated with acute renal failure due to the large sucrose load. By taking certain precautions, especially in high-risk patients, this uncommon, but serious, adverse effect can be avoided.     

核素肾动态显像当日再进行骨显像的可行性

目的 观察肾动态显像当日进行全身骨显像对骨显像图像质量及患者的安全性的影响。方法 选取检查申请中既有肾动态显像又有全身骨显像检查的成年患者53例为观察组,常规接受⁹⁹Tc^m-DTPA肾动态显像检查2 h后,再注射⁹⁹Tc^m-MDP,按骨显像流程接受全身检查;另选取53例仅接受骨显像检查患者为对照组。两组于注射⁹⁹Tc^m-MDP后即刻、30 min、1 h、2 h、4 h、6 h、24 h观察患者不良反应。观察两组患者骨显像图像质量,统计图像质量优良率。测量骨后位像T12、L4、髂嵴、肱骨中段、股骨中段和髂骨上2 cm处软组织的放射计数,计算各部位靶/非靶比值（T/NT）值;对两组数据进行统计学分析。结果 两组患者均无不良反应。观察组和对照组肉眼观察图像质量优良率为90.57%（48/53）、92.45%（49/53）,差异无统计学意义（χ²=0.12,P > 0.05）。两组间T12、L4、肱骨中段、股骨中段T/NT值差异均无统计学意义（P均> 0.05）,髂嵴T/NT值差异有统计学意义（t=3.45,P<0.05）。结论 核素肾动态显像检查同日行全身骨显像检查对图像质量无明显影响。     

Noninvasive monitoring of renal blood flow characteristics during acute renal failure in man

Duplex Doppler ultrasound (DDU) was used to study the blood flow characteristics of the renal interlobar artery in 20 subjects with acute renal failure (ARF), 14 subjects with transient impairment of renal function and 23 control subjects with normal function. Renovascular resistance was assessed by pulsatility index (PI) and change in flow velocity by change in mean frequency shift (f). The 99% confidence intervals for PI in the three groups were 3.32–5.46, 1.58–2.34 and 0.99–1.33 respectively. Values for f were 0.2–0.38, 0.5–0.62 and 0.7–1.02 kHz respectively. Ten ARF patients recovered function, 99% confidence intervals for PI just prior to recovery were 0.9–1.48 and for f 0.52–1.02 kHz. There was increased renovascular resistance and reduced intrarenal blood flow velocity at the onset of ARF. These changes persisted during ARF; recovery of function occurred after they returned to normal. Similar, but less marked, changes were found in patients with a transient impairment of function.This study was conducted at Charing Cross Hospital, London     

血液透析滤过治疗急性肾功能衰竭的护理体会

目的：探讨血液透析滤过（HDF）治疗急性肾功能衰竭的护理。方法：使用德国贝朗血滤双泵机，高通透性聚砜膜F60S滤过器进行HDF清除急性肾功能衰竭中小分子尿毒症毒素，进行回顾性分析。结果：行HDF后，少尿期明显缩短，治疗有效率92.2％。结论：HDF治疗急性肾功能衰竭疗效确切。     

Early-onset chronic renal failure as a complication of acute intermittent porphyria

In a retrospective survey of patients who have had a proven attack of acute intermittent porphyria (AIP) in the West of Scotland a highly significant association (p less than 0.001) was observed between AIP and the development of early-onset chronic renal failure. Six patients with AIP and chronic renal failure arising in early middle-age are described. As no other cause could be attributed to the renal failure three possible causal links between these two conditions were considered, namely, enhanced susceptibility to analgesic nephropathy, porphyria-induced hypertension, and nephrotoxic effects of porphyrins and their precursors. We suggest that porphyria-induced hypertension is the most important factor in causing early-onset chronic renal failure in acute intermittent porphyria.     

急性肾功能衰竭的病理类型分析

目的：探讨急性肾功能衰竭（ＡＲＦ）患者的病理类型及预后转归方法：回顾性分析１９８例经临床及肾活检确诊的ＡＲＦ患者病理类型及肾功能恢复状况。结果：（１）因ＡＲＦ行肾活检者的比例呈逐年上升趋势。（２）ＡＲＦ的病理分类包括肾小球疾病（３５．９％）,肾小管－间质性病变（４８．０％）,继发性肾脏病如血管炎一血管病等（１６．２）。（３）引起ＡＲＦ最常 的肾小球疾病是新月肝火４２．３％）和毛细血管内增生性肾炎（     

婴幼儿高钠血症与急性肾功能衰竭的关系

目的探讨婴幼儿高钠血症的发生情况及其与急性肾功能衰竭的关系。方法回顾性分析48例高钠血症的婴幼儿患儿,以基础疾病不同和是否合并急性肾功能衰竭(ARF)进行分组并比较各相关指标。结果48例高钠血症患儿的基础疾病:腹泻病30例,神经系统损害11例,脓毒败血症5例,其他2例。合并ARF者25例,在腹泻病和脓毒败血症患儿中发生率较高。ARF组和非ARF组的血Na+峰值分别为(167.58±11.96)mmol/L和(167.88±12.10)mmol/L,两组比较无统计学意义(P>0.05)。ARF组中,大多数(20/25)患儿的尿Na+排泄分数(FENa)<1%。ARF组的pH值和SB值明显低于非ARF组(P分别<0.05和<0.01)。结论婴幼儿高钠血症主要发生于腹泻病和神经系统损害等基础疾病上,而腹泻病和脓毒败血症患儿较易合并ARF,值得儿科医生警惕。     

急性肾功能衰竭血液透析治疗的临床观察

目的探讨急性肾功能衰竭血液透析治疗的疗效.方法给53例急性肾功能衰竭患者一周2～3次,每次2～4小时的血液透析治疗.结果治愈32例(占60.3%),转慢性透析4例(占7.6%),放弃治疗3例(占5.7%),死亡14例(占26.4%).结论急性肾功能衰竭患者早期血液透析治疗,有利于减少严重并发症,帮助肾功能恢复,提高抢救成功率,减少死亡率.     

急性肾功能衰竭预后危险因素研究

目的 探讨影响急性肾功能衰竭（ARF）患者肾功能恢复率、病死率的危险因素，以指导诊疗，改善预后。方法 通过Logistic回归等方法回顾性分析44例ARF患者的多系统器官功能衰竭（MSOF）发生率，比较高、低分解代谢、伴否MSOF的ARF患者其肾功能恢复率及病死率。结果 高、低分解代谢型ARF患者肾功能恢复率、病死率差异均有显著性（P〈0．01、P〈0．05）。伴否MSOF的ARF患者问其肾功能恢复率，病死率差异均有显著性（均为P〈0．01）。脏器衰竭数目与肾功能恢复率呈显著负相关（r=-0．517，P〈0．01），与病死率呈显著正相关（r=0．78，P〈0．01）。低分解代谢型ARF患者肾功能恢复率是高分解代谢型的13．7倍，不伴MSOF的ARF患者肾功能恢复率是伴MSOF者的27倍，伴MSOF的ARF患者其病死率是不伴MSOF者的68．7倍。结论 对ARF患者应积极寻找并去除导致高分解代谢的原发病因，治疗选药时避免使用损害肾外脏器药物，力争不伴发或少伴发MSOF，这对改善ARF预后有利。     

Bilateral stones as a cause of acute renal failure in the emergency department

BACKGROUND:

Acute renal failure (ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But occasionally the cause of obstruction may be elusive.

METHODS:

We present a case of obstructive uropathy due to bilateral stones presenting as acute renal failure. The patient underwent successful shock wave lithotripsy (SWL) for dissolution of calculi.

RESULTS:

The patient was successfully treated, and reported asymptomatic in a follow-up.

CONCLUSION:

Close collaboration between nephrological, urological, and radiological services is required.KEYWORDS: Bilateral stones, Acute renal failure, Obstructive uropathy     

Update on dialytic management of acute renal failure

The potential impact of renal replacement therapy on clinical outcomes in acute renal failure (ARF) remains a subject of ongoing investigation and controversy. This article reviews in depth the clinical trials to date that have examined the effect of dialysis-related variables on outcomes of patients with hospital-acquired ARF. In particular, the role of the dialysis modality, dialyzer characteristics, and dosing strategies are discussed. Clinical trials comparing intermittent hemodialysis (HD) to continuous renal replacement therapies (CRRT) have failed to demonstrate a survival difference when adjusting for disease severity. Similarly, studies evaluating dialyzer membrane biocompatibility and flux properties had no impact on survival. Efforts aimed at measuring dialysis adequacy in patients with ARF receiving HD using urea kinetic modeling are hindered by a lack of understanding of solute kinetics in this setting. However, dosing strategies during CRRT are promising. Finally, the application of cell therapy to the successful substitution of renal function shows promise for the future.     

Physiologic consequences of acute renal failure on the critically ill

Acute renal failure (ACF) causes increased levels of uremic retention products, acidosis, and volume overload. These factors contribute to a dysregulated inflammatory response and decreased immunity, and interfere with normal function of many organs. ACF may play an important role in the etiology of multiple organ dysfunction.     

肾性急性肾衰竭CT表现分析

目的：分析肾性急性肾衰竭（acute renal failure,ARF）的影像表现以及病理基础。方法：对40例肾性ARF患者的临床资料和影像资料进行回顾性分析。结果：急性胰腺炎所致肾性ARF患者3例（7.5%）;感冒应用抗病毒药物所致急性肾性ARF患者8例（20%）;非甾体药物（NSAIDs）所致ARF患者3例（7.5%）;多发性骨髓瘤伴发急性肾性ARF患者4例（10%）,肺炎应用抗生素药物所致急性肾性ARF患者9例（22.5%）;恶性肿瘤化疗后急性肾性ARF患者13例（32.5%）、其中合并2型糖尿病基础病患者7例（17.5%）。肾性ARF累及双侧肾脏,其影像表现为双侧肾脏外形增大、肾脏实质密度减低、桥隔增厚、吉氏筋膜增厚、纤维膜增厚。结论：肾性ARF的发生与药物、感染和肿瘤关系紧密,并在影像学上存在相应的影像表现。     

Continuous haemofiltration in acute renal failure with prostacyclin as the sole anti-haemostatic agent

OBJECTIVE: To investigate the safety and efficacy of a synthetic prostacyclin analogue (epoprostenol) for circuit maintenance during continuous veno-venous haemofiltration (CVVH) in patients with acute renal failure (ARF). DESIGN: Observational case study. SETTING: University-affiliated six-bed intermediate renal care unit in a nephrology and internal medicine department of a 1300-bed teaching hospital. PATIENTS: A consecutive series of critically ill ARF patients in whom prostacyclin was the sole anti-haemostatic agent used for CVVH. INTERVENTIONS: Bicarbonate-based CVVH in pre-dilution (1.5 l/h); blood flow rate at 200 ml/min; prostacyclin at 4 ng/kg per min infusion in the extracorporeal circuit before the haemofilter. MEASUREMENTS AND MAIN RESULTS: Fifty-one ARF patients (mean APACHE II 27.2, SD 7.8; acute tubular necrosis in 44/51, 83%; mechanical ventilation 14/51, 21%; in-hospital mortality 28/51, 54%) underwent CVVH for a total of 4040 h (230 circuits, median number 4 circuits per patient, range 1-13). Four patients out of 51 (7.8%) experienced major bleeding during CVVH (1.0 episode per 1000 patient-hours of treatment; 95%CI, 0.4-2.6); no death could be attributed to haemorrhage. Therapeutic intervention for hypotension (fluids and/or vasopressors) was required in 15.5% of the CVVH sessions monitored. The median duration of the circuit was 15.0 h (95% CI, 13.0-16.5). CONCLUSIONS: The use of prostacyclin as the sole anti-haemostatic agent for CVVH entails a low risk of haemorrhagic complications, while maintaining the patency of the circuit long enough to allow the delivery of an adequate dose of renal replacement therapy. Further studies are needed to compare this technique to other anti-haemostatic strategies for CVVH.     

Penicillin-induced acute renal failure as a rare severe complication of erysipelas treatment

Penicillins are the most commonly used antibiotics in dermatology owing to their bacteriocidal effect and the high responsiveness of most bacterial dermatoses to penicillin treatment. Although there is a wide range of adverse reactions to penicillins, severe complications are seen very rarely. We report on two cases of penicillin-induced acute interstitial nephritis and summarize the characteristic features of this serious adverse reaction to penicillin administration.     

Diagnosis and management of glomerulonephritis and vasculitis presenting as acute renal failure

Acute and rapidly progressive renal failure is caused by a number of pathogenetically distinct types of glomerulonephritis, some of which are associated with systemic vasculitis. In a given patient, accurate diagnosis of the specific type of glomerulonephritis is essential for optimum treatment. Making a specific diagnosis usually requires renal biopsy or serologic analysis. The two categories of treatment for glomerulonephritis are (1) treatment for the pathophysiologic complications of glomerulonephritis, such as hypertension, fluid overload, and uremia, and (2) treatment for the inflammatory injury, which usually employs immunosuppression with steroids and cytotoxic drugs.     

兔急性肾功能衰竭时肾实质背向散射积分与病理对照的实？…

目的探讨兔急性肾功能衰竭（ＡＲＦ）时肾实质背向散射积分（ＩＢＳ）的变化情况及其与病理改变的关系。方法兔后腿肌注５０％的甘油１２～１５ｍｌ／ｋｇ,建立急性肾小坏死性ＡＲＦ动物模型,分别于注射前（Ｔ０）、注射后１、３…１３ｄ（Ｔ１、Ｔ３…Ｔ１３）共８个时间点行超声检查,测定肾皮质、肾髓质及肾窦区ＩＢＳ值,分别以肾皮质ＩＢＳ、肾髓质ＩＢＳ与肾窦区ＩＢＳ之比为肾皮质、肾髓质校正ＩＢＳ值（ＩＢＳ％）。将测定