A Case Report of the Osmotic Nephrosis Following Multiples Fractures

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A 20-years young man suffered from the fractures of the both femurs, of the right lower leg and of the right patella. He was given blood-, fructose and aminoacid transfusion. The abnormality of the physiochemical examination in blood and in urine except for anemia was not evident for 5 days.However, symptome of uremia has appeared since the eighth day, with increasing levels of blood urea or non protein and oliguria, and he died of uremia on the fourteenth day. At autopsy, the kidneys became grossly, as large, swollen, and edematous (right 178gr, left 190gr.). Microscopically, the marked hydropic swelling of the epithelium in the proximal portion of the nephron and slight degeneration and necrotic changes of the epithelium in the distal portion of the nephron with the presence of heme cast were foundThe former is "osmotic nephrosis" and the latter is "lower nephron nephrosis". No changes were observed in the glomeruli. Therefore it is suggested that slight lower nephron nephrosis resulted from the multiple fractures, marked osmotic nephrosis followed from a large quantity of fructose transfusion and functional disturbance of the kidneys has been produced by them.
西日本整形・災害外科学会の論文