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Gideon Koren, MD; Yedidia Bentur, MD; Dawn Strong, PharmD; Elizabeth Harvey, MD; Julia Klein, MSc; Reuben Baumal, MD, PhD; Stephen P. Spielberg, MD, PhD; Melvin H. Freedman, MD

Am J Dis Child. 1989;143(9):1077-1080.

Abstract
• In three patients who received intravenous deferoxamine there was a twofold to eightfold increase in plasma creatinine level and a parallel decrease in creatinine clearance that resolved when treatment with the drug was discontinued. In two thalassemic patients, diuresis was evident by urine output exceeding fluid intake. The mechanism was studied in dogs that exhibited an acute and significant decrease in inulin and para-aminohippuric acid clearances induced by intravenous deferoxamine. Saline diuresis could prevent the decrease in the glomerular filtration rate but not the decrease in renal blood flow caused by deferoxamine. Deferoxamine induced an acute increase in the fractional excretion of sodium, potassium, chloride, phosphate, and urate, which may explain the relative diuresis observed in two of the patients. In a subsequent experiment, ferrioxamine induced an increase in the fractional excretion of sodium and chloride but did not affect the glomerular filtration rate and renal blood flow. Our studies suggest that adequate hydration may be needed to preserve renal hemodynamics during intravenous deferoxamine therapy. Repeated measurements of renal function should accompany treatment with this agent.

(AJDC. 1989;143:1077-1080)

Author Affiliations
From the Divisions of Clinical Pharmacology (Drs Koren, Bentur, and Spielberg and Ms Klein), Nephrology (Drs Strong and Harvey), and Hematology-Oncology (Dr Freedman), the Departments of Pediatrics (Drs Koren, Bentur, Harvey, Spielberg, and Freedman and Ms Klein), Pharmacy (Dr Strong), and Pathology (Dr Baumal), and The Research Institute (Drs Koren, Bentur, Strong, Harvey, Baumal, Spielberg, and Freedman and Ms Klein), The Hospital for Sick Children, and the Departments of Pediatrics (Drs Koren, Bentur, Harvey, Spielberg, and Freedman and Ms Klein) and Pharmacology (Drs Koren and Spielberg), University of Toronto, Canada. Dr Koren is a career scientist with the Ontario Ministry of Health.

Footnotes
Accepted for publication April 4, 1989.

Presented at the Annual Scientific Meeting of the American Academy of Clinical Toxicology, Baltimore, Md, October 4, 1988.

Reprint requests to Division of Clinical Pharmacology, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1x8 (Dr Koren).

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