[Effect of hydroxyethyl starch solution on kidney function in surgical intensive care patients]

Abstract

Hydroxyethyl starch is commonly used in resuscitation, anaesthesia and intensive care medicine. Increasing creatinine values in patients treated with hydroxyethyl starch have been described in some case reports. These have also been some clinical signs such as pain in the renal region, and swelling of kidney parenchyma, but no differential and sensitive parameters of renal function have supported these possible side effects of hydroxyethyl starch. Twenty-five patients were randomly allocated to a control and a treatment group. In the treatment group, patients received 12 ml per kg body-weight hydroxyethyl starch 10% (200/0.5) daily. A non-invasive diagnostic spectrum of renal function was performed. Specific tubular proteins (alpha 1-microglobulin, Tamm-Horsfall protein), glomerular parameters (immunoglobulin G, albumin), and the brush border enzyme acetyl-beta-glucosaminidase, were examined. Additionally, renal blood flow and glomerular filtration rate, Apache-II-score, breathing therapy, infusions, transfusion, and all medical interventions were documented. Both groups were comparable with regard to drug therapy. Apache-II-score, and fluid management. There were differences in tubular function between the two groups. Patients undergoing HES therapy showed increased excretion of alpha 1-microglobulin. Tamm-Horsfall-protein and of brush border enzyme acetyl-beta-glucosaminidase. No significant differences were detectable in glomerular functions (glomerular filtration rate, renal blood flow), albumin, and IgG. Correlates of tubular damage after hydroxyethyl starch therapy were seen in intensive care patients. Many influences of intensive therapy act on renal function, and further studies with larger cohorts are necessary. With regard to the documented localisation of the tubular damage in the HES group, colloid therapy with hydroxyethyl starch in renal dysfunction should be monitored carefully by means of sensitive markers.