Abstract
Dextran 40 is a low molecular weight dextran preparation which is used as an adjunctive treatment in hypovolemic shock. At present dextran 40 is mainly used in the clinical practice for management of severe cases of dengue haemorrhagic fever or dengue shock syndrome. Acute kidney injury is a rare adverse reaction of dextran administration. We report a case of dextran induced acute kidney injury complicated with hypertensive encephalopathy during the convalescent phase of the illness. Renal biopsy revealed fine isometric vacuolations of tubular epithelial cells suggestive of osmotic nephrosis.
Highlights
Dextran 40 is a low molecular weight dextran preparation which is used as an adjunctive treatment in hypovolemic shock
While the majority of individuals who are infected with the dengue virus develop asymptomatic or an undifferentiated viral fever like illness, it can cause severe clinical manifestations such as dengue hemorrhagic fever leading to shock and organ involvement in 10-25% of individuals[1]
Patients who develop acute kidney injury (AKI) prior to hospital admission carry a higher risk of mortality compared to the patients who develop AKI during hospital stay[4]
Summary
Fever was high grade with associated arthralgia, myalgia, headache and vomiting He had been in good health previously and denied a history of leptospirosis exposure. Ultrasound scan of abdomen showed normal sized kidneys with increased renal echogenicity suggestive of acute kidney injury (AKI). Serology was positive for dengue IgG & IgM antibodies and leptospirosis antibody was negative on 7th day of illness His creatinine levels started to normalize after 8th day of illness and urine output was satisfactory. One week after the discharge, on 20th day of illness, he presented to the emergency treatment unit with generalized tonic-clonic convulsions The interstitium showed mild acute on chronic inflammation with fibrosis and oedema (Figure 1) These tubular changes were compatible with changes seen in osmotic tubular injury. There were no recurrent episodes of seizures and blood pressure was controlled with anti-hypertensive medications
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