Letter 10% Hydroxyethylstarch impairs renal function and induces interstitial proliferation, macrophage infiltration and tubular damageSiegemund

Huter and colleagues recently published an experimentalpaper about possible pathomechanisms of hydroxyethyl-starch (HES)-induced adverse effects on renal function in anisolated perfusion model of 6 hours [1]. The authors shouldbe congratulated for their attempt to shed light on theinfluence of different HES preparations on renal function,combining functional results and histological data.In the recently published prospective, randomized, controlledEfficacy of Volume Substitution and Insulin Therapy in SevereSepsis (VISEP) trial, 10% HES 200/05 caused a close tosignificant increase in 90-day mortality in septic patients.Renal failure and renal replacement therapy significantlyincreased dose dependently compared with Ringer’s lactatetreatment. Unfortunately, 100 out of 262 patients in the HESgroup received more than the maximum allowed daily dose onat least 1 day, the majority occurring on the first day afterstudy inclusion. The patients without a violation of themaximum daily dose administration had a mortality rate evenlower than that in the Ringer’s lactate group [2].In their isolated renal perfusion model, Huter and colleaguestried to answer some of the questions originating from theVISEP trial, comparing 10% HES 200/0.5, 6% HES 130/0.42and Ringer’s lactate [1]. The hyperoncotic 10% HES, used inthe VISEP study, showed severe oliguria, impaired potassiumexcretion and signs of lysosomal tubular damage. In contrast,isovolemic 6% HES showed no difference compared withRinger’s lactate in creatinine clearance, sodium excretion and