Ranking of symptoms by patients with the irritable bowel syndrome.

proximal tubule and the formation of casts, which obstruct the flow of tubular fluid.3 Dextran solutions may perhaps cause a functional reduction in glomerular filtration by raising plasma oncotic pressure4 and, after filtration and concentration in the proximal tubule, by raising tubular hydrostatic pressure.' Plasma oncotic pressure was normal in our patient, although we did not measure it until 48 hours after the operation and thus may have missed a transient increase. This, however, would have been only a contributory factor in the development of the renal failure as there was clear evidence of severe structural damage to the kidney. We recommend that infusions of large amounts of Gelofusine should be avoided in patients with persistently low renal perfusion pressures or rates of urine flow.