Acute renal failure following massive mannitol infusion

Am J Nephrol. 2002 Sep-Dec;22(5-6):573-5. doi: 10.1159/000065279.

Abstract

Mannitol overuse-induced acute renal failure (ARF) has rarely been described. We report four cases, all male, between the ages of 20 and 42 years, who developed acute renal failure (3 anuric, 1 nonoliguric) after receiving mannitol 1,172 +/- 439 g (mean +/- SD) during a time period of 58 +/- 28 h. The infusion rate was 0.25 +/- 0.02 g/kg/h. The onset of acute renal failure was detected 48 +/- 22 h after infusion. In 2 of the 3 cases in which urinary cytology was evaluated, the presence of vacuole-containing renal tubular cells was observed. All patients had hyponatremia (120 +/- 11 mEq/l), and hyperosmolality (osmolar gap 70 +/- 11 mosm/kg water). No other factors could be pointed to as causing acute renal failure. In the 3 anuric cases in which hemodialysis was performed, immediate recovery of diuresis was observed. Two patients recovered renal function on the fifth and sixth days, and 2 died due to endocranial hypertension - one of them while recovering - on the fourth and sixth days. In the present report, mannitol-induced ARF occurred at clustered doses of 0.25 mg/kg/h.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / therapy
  • Adult
  • Diuretics, Osmotic / administration & dosage*
  • Diuretics, Osmotic / adverse effects*
  • Humans
  • Hypernatremia / chemically induced
  • Male
  • Mannitol / administration & dosage*
  • Mannitol / adverse effects*
  • Osmolar Concentration
  • Renal Dialysis
  • Urine / cytology

Substances

  • Diuretics, Osmotic
  • Mannitol