Studies on intravascular hemolysis in man: the pathogenesis of the initial stages of acute renal failure.

Intravascular hemolysis of moderate or severe degree in man is often followed by acute renal failure. Most studies of renal function have been carried out on patients during or after the oliguric or anuric phase and have, therefore, shed little information on pathogenesis of the renal failure. The present studies were undertaken to clarify the changes in renal function which precede anuria resulting from intravascular hemolysis. It was hoped that the onset of acute renal failure might be prevented if the means of reversing the early changes could be found. The changes in renal function in 10 patients during intravascular hemolysis induced by the intravenous infusion of distilled water are described in this report. The infusions were given slowly, carefully controlled, and often continued for many hours. The resulting alterations in renal function rapidly returned toward normal after the infusion of water was discontinued or after the intravenous injection of Parathormone. The initial justification for this study rested on observations of the changes in renal function in a patient during and after the accidental intravenous infusion of distilled water. She developed anuria but urine flow was reestablished and her inulin clearance returned to normal 30 minutes after the intravenous injection of Parathormone. Twelve weeks later her inulin clearance was 140 ml. per min. per 1.73m2, Diodrast clearance 420 ml. per min. per 1.73m2, but Tm Diodrast was only 11 mg. per min. per 1.73m2. Clinical assessment of her renal function, including urine concentration tests, during the next three years has revealed no abnormality. Patients with impaired renal function, as shown by a urine concentration test and routine clinical