Assessment of Hydroxyethyl Starch (6% HES 130/0.4) Kidney Storage in Critically Ill Dogs: A Post-mortem Prospective Study

Katja-Nicole Adamik; Michael H Stoffel; Simone Tangermann; Bettina de Breuyn Dietler; Nadine Stokar-Regenscheit

doi:10.3389/fvets.2021.802507

Assessment of Hydroxyethyl Starch (6% HES 130/0.4) Kidney Storage in Critically Ill Dogs: A Post-mortem Prospective Study

Front Vet Sci. 2022 Jan 6:8:802507. doi: 10.3389/fvets.2021.802507. eCollection 2021.

Authors

Katja-Nicole Adamik¹, Michael H Stoffel², Simone Tangermann³, Bettina de Breuyn Dietler⁴, Nadine Stokar-Regenscheit²

Affiliations

¹ Division of Small Animal Emergency and Critical Care, Department of Veterinary Clinical Medicine, University of Bern, Bern, Switzerland.
² Division of Veterinary Anatomy, Department of Clinical Research and Veterinary Public Health, University of Bern, Bern, Switzerland.
³ Department of Infectious Diseases and Pathobiology, Institute of Animal Pathology of the Vetsuisse Faculty, University of Bern, Bern, Switzerland.
⁴ Division of Topographic and Clinical Anatomy, Institute of Anatomy, University of Bern, Bern, Switzerland.

Abstract

Objective: Intravenous hydroxyethyl starch (HES) solutions are potentially nephrotoxic due to rapid renal tissue uptake, subsequent osmotic nephrosis, and long-lasting intracellular storage. This study aimed to investigate the severity of intracellular storage of HES in renal tissue samples from critically ill dogs receiving 6% HES 130/0.4. Materials and Methods: Fresh, post-mortem (<2 h after death) renal tissue samples were analyzed through histology, immunohistochemistry (HES 130/0.4-specific antibodies), and electron microscopy for the severity of renal tubular vacuolization (VAC), intravacuolar HES accumulation (ACC), and ultra-structure impairment. Moreover, we investigated the relationship between VAC or ACC grade and HES dose (mL/kg), duration of HES administration (h), and pre-HES plasma creatinine concentrations. Results: Histology revealed that 2/20 dogs (10%) had no, 11/20 dogs (55%) had mild, 5/20 dogs (25%) had moderate, and 2/20 dogs (10%) had severe VAC. Immunohistochemistry revealed that 5/20 dogs (25%) had no, 6/20 dogs (30%) had mild, 7/20 dogs (35%) had moderate, and 2/20 dogs (10%) had severe ACC. Both changes were predominantly found in the distal tubular epithelium of mild and moderate cases, and all tubular segments were affected in severe cases. Seven of 20 dogs (35%) had osmotic nephrosis (ON). On electron microscopy, large granules with an electron-dense content were repeatedly detected in individual cells, mainly in the distal tubules. No correlation was found between cumulative HES dose or duration of HES administration and VAC grade, ACC grade, or presence/absence of ON. Conclusion: A high percentage of dogs had renal tubular HES storage and one-third of dogs showed HES-induced ON. Short-term HES administration caused VAC and ACC, regardless of the dose or duration of administration. In contrast to previous studies, HES 130/0.4 deposits were mainly located in the renal distal tubule.

Keywords: AKI; fluid therapy; osmotic nephrosis; synthetic colloids; tetrastarch.