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Acute Renal Fail Induced by Dextran 40 – A Case Report
Dextran 40引起之急性腎衰竭：一病例報告
摘要
Dextran在臨床上做為血漿替代品，更有抗凝集以及改善微小循環的作用；然而，Dextran也可引起急性腎衰竭。我們報告一位74歲男性，因突發之聽力喪失住院，住院當時腎功能是正常的。病人接受10% dextran 40加在5% dextrose中治療，每12小時給予500毫升，總共給予6天。住院第七天時，病人出現噁心、嘔吐、以及尿量減少的現象，抽血檢查發現急性腎衰竭。病人接受腎臟切檢查，其結果顯示近端腎小管細胞有空泡樣變化及細胞退化現象。停用dextran後病人之腎功能漸漸改善，並沒有接受透析或血漿交換術治療。在使用Dextran時，我們的建議是必須密切地監測尿量及腎臟功能。如有尿量減少或腎功能惡化時，必須馬上停止使用Dextran，並給予適當的治療。
並列摘要
Dextran has been used as plasma volume expander and as prophylactic agent against intravascular thrombosis. However, acute renal failure induced by dextran can occasionally be seen. We report a 74-year-old male patient who suffered from a sudden onset of hearing loss. Laboratory results at admission reveled normal renal function. He was given low molecular weight dextran, 10% dextran 40 in 5% dextrose, at a rate 500 ml every 12 hours for 6 days, with low dose steroid for treatment of hearing loss. Acute renal failure was found with nausea and vomiting at day seven, and his urinary output decreased. Renal biopsy revealed vacuolation and degeneration of proximal tubular cells and narrowing of tubular lumen. His condition improved gradually loater without dialysis or plasmpheresis. We suggest that dextran cannot be used indiscriminately and close monitoring of urine output and renal function are mandatory when using dextran.