Visweswaran P, Massin E K, Dubose T D
Department of Internal Medicine, University of Texas Medical School, Houston 77030, USA.
J Am Soc Nephrol. 1997 Jun;8(6):1028-33. doi: 10.1681/ASN.V861028.
The osmotic diuretic mannitol may be used in diverse clinical settings, such as providing "renal protection" in patients at risk for acute renal failure, decreasing intracranial pressure in patients with intracranial trauma, and preventing the dialysis-disequilibrium syndrome. Mannitol is commonly used after cardiac catheterization, cardiovascular surgery, and exposure to intravenous contrast dyes. This study presents a case in which a long-term renal transplant recipient receiving cyclosporine therapy concomitantly developed acute renal failure after the administration of high-dose mannitol in an attempt to induce an osmotic diuresis. The diagnosis of "osmotic nephrosis" was confirmed by renal biopsy, and the condition was reversed by cessation of the agent. Studies in experimental animals indicate that cyclosporin A can potentiate the tubular toxicity of mannitol, but such an association has not been verified in humans. Numerous studies confirm the nephrotoxic potential of high-dose mannitol, especially in patients with renal insufficiency. The clinical utility of the osmolar gap in preventing mannitol nephrotoxicity is emphasized.
渗透性利尿剂甘露醇可用于多种临床情况，如为有急性肾衰竭风险的患者提供“肾脏保护”、降低颅内创伤患者的颅内压以及预防透析失衡综合征。甘露醇常用于心脏导管插入术后、心血管手术后以及接触静脉造影剂后。本研究报告了一例长期接受环孢素治疗的肾移植受者，在试图诱导渗透性利尿而给予大剂量甘露醇后，并发急性肾衰竭。肾活检证实了“渗透性肾病”的诊断，停用该药物后病情得到逆转。对实验动物的研究表明，环孢素A可增强甘露醇的肾小管毒性，但这种关联在人类中尚未得到证实。大量研究证实了大剂量甘露醇的肾毒性潜力，尤其是在肾功能不全的患者中。强调了渗透压间隙在预防甘露醇肾毒性方面的临床实用性。
