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November 1984

Acute Renal Failure Following Massive Mannitol Infusion Appropriate Response of Tubuloglomerular Feedback?

Author Affiliations

From the Nephrology Division, Department of Medicine, Albert Einstein College of Medicine and Bronx Municipal Hospital Center, New York City.

Arch Intern Med. 1984;144(11):2214-2216. doi:10.1001/archinte.1984.04400020132020

• Two patients suffered reversible acute oligoanuric renal failure following massive mannitol infusion (400 to 900 g/day) given as treatment for intracranial hypertension. We believe this to be a previously unreported complication. Both patients had normal renal function before therapy. Serum creatinine level rose to 7.4 mg/dL (654 μmole/L) in patient 1 and to 2.7 mg/dL (238 μmole/L in patient 2. Measured and calculated serum osmolality were 362 and 301 mOsm/kg, respectively, in patient 1 and 333 and 220 mOsm/kg, respectively, in patient 2. Other causes of renal failure were excluded. We postulate that the mannitol-induced increase in solute delivery to the macula densa may have triggered an intense tubuloglomerular feed-back response resulting in a marked fall in glomerular filtration rate. Alternatively, mannitol infusion may have caused tubular cell swelling with luminal obstruction.

(Arch Intern Med 1984;144:2214-2216)

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