Complication of oliguric acute renal failure in patients treated with low-molecular weight dextran

Acute renal failure (ARF) is a well-documented but infrequent complication in patients treated with low-molecular weight dextran (LMWD). We herein rep ort 3 cases of oliguric ARF following the administration of dextran-40. One case developed ARF totally after 1.200 g of LMWD administration. In contra st, two cases having increased serum creatinine developed oliguria despite the acceptable therapeutic doses (totally 450 and 650g). Contrast media was also co-administered in these patients. Plasma exchange (PE), double filtr ation plasmapheresis (DFPP), or continuous hemodiafiltration (CHDF) but not hemodialysis (HD) reduced circulating dextran concentrations by 35-44% dur ing a single session. All patients completely recovered from ARF by 14-32 d ays after the treatment. Our cases suggested that radiocontrast could predi spose to the development of LMWD-induced ARF especially in patients having preexisting renal dysfunction. In addition, PE, DFPP and CHDF afforded a be neficial effect for removing accumulated LMWD from the circulation.