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Ogurlu B, Hamelink TL, Lantinga VA, Leuvenink HGD, Pool MBF, Moers C. Furosemide attenuates tubulointerstitial injury and allows functional testing of porcine kidneys during normothermic machine perfusion. Artif Organs 2024; 48:595-605. [PMID: 38164041 DOI: 10.1111/aor.14705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/24/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Normothermic machine perfusion (NMP) is a promising pretransplant kidney quality assessment platform, but it remains crucial to increase its diagnostic potential while ensuring minimal additional injury to the already damaged kidney. Interventions that alter tubular transport can influence renal function and injury during perfusion. This study aimed to determine whether furosemide and desmopressin affect renal function and injury during NMP. METHODS Eighteen porcine kidneys (n = 6 per group) were subjected to 30 min of warm ischemia and 4 h of oxygenated hypothermic perfusion before being subjected to 6 h of NMP. Each organ was randomized to receive no drug, furosemide (750 mg), or desmopressin (16 μg) during NMP. RESULTS Compared with the other groups, the addition of furosemide resulted in significantly increased urine output, fractional excretion of sodium and potassium, and urea clearance during NMP. Urinary neutrophil gelatinase-associated lipocalin levels decreased significantly with furosemide supplementation compared with the other groups. The addition of desmopressin did not result in any significantly different outcome measurements compared with the control group. CONCLUSIONS This study showed that the addition of furosemide affected renal function while attenuating tubulointerstitial injury during NMP. Therefore, furosemide supplementation may provide renal protection and serve as a functional test for pretransplant kidney viability assessment during NMP.
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Affiliation(s)
- Baran Ogurlu
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim L Hamelink
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Veerle A Lantinga
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henri G D Leuvenink
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Merel B F Pool
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cyril Moers
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Zhou L, Li Y, Gao Q, Lin Y, Su L, Chen R, Cao Y, Xu R, Luo F, Gao P, Zhang X, Li P, Nie S, Tang Y, Xu X. Loop Diuretics Are Associated with Increased Risk of Hospital-Acquired Acute Kidney Injury in Adult Patients: A Retrospective Study. J Clin Med 2022; 11:jcm11133665. [PMID: 35806949 PMCID: PMC9267783 DOI: 10.3390/jcm11133665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The association between loop diuretics and acute kidney injury (AKI) remains unclear. Methods: The population studied was selected from the Epidemiology of AKI in Chinese Hospitalized patients (EACH) study. Exposure to loop diuretics was defined as any filled prescription prior to the date when AKI was detected in patients with HA-AKI, and prior to the last date of SCr testing in those without AKI. The outcome was AKI, defined by the Kidney Disease Improving Global Outcomes criteria. Associations between loop diuretics and HA-AKI were examined by Cox proportional hazards models adjusted for baseline and time-dependent covariates. Results: Of the 150,020 patients, 16,437 (11.0%) were prescribed loop diuretics, and 5717 (3.8%) experienced HA-AKI events. The crude rates of HA-AKI in patients who were and were not prescribed loop diuretics were 1632 (9.9%) and 3262 (2.8%), respectively. A multivariate cox proportional hazards analysis showed that exposure to loop diuretics was associated with significantly increased risks of HA-AKI compared with non-users (hazard ratio (HR), 1.61; 95% CI (confidence interval), 1.55–1.67), other diuretics (HR, 1.09; 95% CI, 1.03–1.15), and osmotic diuretics (HR, 1.30; 95% CI, 1.20–1.42). Compared with other diuretics, the use of loop diuretics was associated with higher risks of HA-AKI in women, in patients without hypertension, in patients without heart failure, in patients without liver cirrhosis, and in patients not requiring surgery. Conclusions: Loop diuretics are widely used and are associated with increased risks of HA-AKI in hospitalized adults. Renal function should be more closely monitored during the use of loop diuretics.
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Affiliation(s)
- Liping Zhou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Yanqin Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Qi Gao
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Yuxin Lin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Licong Su
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Ruixuan Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Yue Cao
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Ruqi Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Fan Luo
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Peiyan Gao
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Xiaodong Zhang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Pingping Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Sheng Nie
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Ying Tang
- Division of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510515, China
- Correspondence: (Y.T.); (X.X.)
| | - Xin Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
- Correspondence: (Y.T.); (X.X.)
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Pitta RD, Gasparetto J, De Moraes TP, Telles JP, Tuon FF. Antimicrobial therapy with aminoglycoside or meropenem in the intensive care unit for hospital associated infections and risk factors for acute kidney injury. Eur J Clin Microbiol Infect Dis 2019; 39:723-728. [PMID: 31832808 DOI: 10.1007/s10096-019-03779-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Abstract
There have historically been concerns of acute kidney injury (AKI) with the use of aminoglycosides. The present study aimed to compare the AKI incidence and mortality rate between critically ill patients treated with aminoglycoside or meropenem in the intensive care unit setting using a propensity score matching approach. This cross-sectional study was conducted at two university hospitals from January 2011 to October 2017. Clinical and laboratorial data were evaluated to exclude potential confounders and to calculate the Charlson index. AKI was classified according to the Acute Kidney Injury Network criteria. All tests were two-tailed, and a p value ≤ 0.05 was considered significant in the univariate and multivariate analyses. We included 494 patients, 95 and 399 of whom used meropenem and aminoglycoside, respectively. Patients in the subgroup that used meropenem were matched with controls (aminoglycoside). Among the 494 patients, 120 developed any grade of AKI (24.2%). After propensity score matching, there were no significant differences in AKI incidence and mortality rate between the aminoglycoside and meropenem groups (p = 0.324 and 0.464, respectively). Patients on the aminoglycoside regimen neither presented a higher AKI incidence nor mortality rate when compared with those on the meropenem regimen. Aminoglycosides may be a safe option for the treatment of critically ill patients on carbapenem sparing antimicrobial stewardship programs.
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Affiliation(s)
- Raphael Donadio Pitta
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Juliano Gasparetto
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Thyago Proença De Moraes
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - João Paulo Telles
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Felipe Francisco Tuon
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.
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Briguori C, Visconti G, Donahue M, De Micco F, Focaccio A, Golia B, Signoriello G, Ciardiello C, Donnarumma E, Condorelli G. RenalGuard system in high-risk patients for contrast-induced acute kidney injury. Am Heart J 2016; 173:67-76. [PMID: 26920598 DOI: 10.1016/j.ahj.2015.12.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/04/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND High urine flow rate (UFR) has been suggested as a target for effective prevention of contrast-induced acute kidney injury (CI-AKI). The RenalGuard therapy (saline infusion plus furosemide controlled by the RenalGuard system) facilitates the achievement of this target. METHODS Four hundred consecutive patients with an estimated glomerular filtration rate ≤30 mL/min per 1.73 m(2) and/or a high predicted risk (according to the Mehran score ≥11 and/or the Gurm score >7%) treated by the RenalGuard therapy were analyzed. The primary end points were (1) the relationship between CI-AKI and UFR during preprocedural, intraprocedural, and postprocedural phases of the RenalGuard therapy and (2) the rate of acute pulmonary edema and impairment in electrolytes balance. RESULTS Urine flow rate was significantly lower in the patients with CI-AKI in the preprocedural phase (208 ± 117 vs 283 ± 160 mL/h, P < .001) and in the intraprocedural phase (389 ± 198 vs 483 ± 225 mL/h, P = .009). The best threshold for CI-AKI prevention was a mean intraprocedural phase UFR ≥450 mL/h (area under curve 0.62, P = .009, sensitivity 80%, specificity 46%). Performance of percutaneous coronary intervention (hazard ratio [HR] 4.13, 95% CI 1.81-9.10, P < .001), the intraprocedural phase UFR <450 mL/h (HR 2.27, 95% CI 1.05-2.01, P = .012), and total furosemide dose >0.32 mg/kg (HR 5.03, 95% CI 2.33-10.87, P < .001) were independent predictors of CI-AKI. Pulmonary edema occurred in 4 patients (1%). Potassium replacement was required in 16 patients (4%). No patients developed severe hypomagnesemia, hyponatremia, or hypernatremia. CONCLUSIONS RenalGuard therapy is safe and effective in reaching high UFR. Mean intraprocedural UFR ≥450 mL/h should be the target for optimal CI-AKI prevention.
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Affiliation(s)
- Carlo Briguori
- Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
| | - Gabriella Visconti
- Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Michael Donahue
- Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Francesca De Micco
- Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Amelia Focaccio
- Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Bruno Golia
- Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Giuseppe Signoriello
- Department of Mental Health and Preventive Medicine, Second University of Naples, Naples, Italy
| | | | | | - Gerolama Condorelli
- Department of Cellular and Molecular Biology and Pathology, "Federico II" University of Naples, Naples, Italy
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Youssef MI, Mahmoud AA, Abdelghany RH. A new combination of sitagliptin and furosemide protects against remote myocardial injury induced by renal ischemia/reperfusion in rats. Biochem Pharmacol 2015; 96:20-9. [DOI: 10.1016/j.bcp.2015.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 04/16/2015] [Indexed: 01/12/2023]
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Levi TM, Rocha MS, Almeida DN, Martins RTC, Silva MGC, Santana NCP, Sanjuan IT, Cruz CMS. Furosemide is associated with acute kidney injury in critically ill patients. Braz J Med Biol Res 2012; 45:827-33. [PMID: 22641414 PMCID: PMC3854324 DOI: 10.1590/s0100-879x2012007500093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 05/21/2012] [Indexed: 12/13/2022] Open
Abstract
Acute kidney injury (AKI) is common in critically ill patients. Diuretics are used without any evidence demonstrating a beneficial effect on renal function. The objective of the present study is to determine the incidence of AKI in an intensive care unit (ICU) and if there is an association between the use of furosemide and the development of AKI. The study involved a hospital cohort in which 344 patients were consecutively enrolled from January 2010 to January 2011. A total of 132 patients (75 females and 57 males, average age 64 years) remained for analysis. Most exclusions were related to ICU discharge in the first 24 h. Laboratory, sociodemographic and clinical data were collected until the development of AKI, medical discharge or patient death. The incidence of AKI was 55% (95%CI = 46-64). The predictors of AKI found by univariate analysis were septic shock: OR = 3.12, 95%CI = 1.36-7.14; use of furosemide: OR = 3.27, 95%CI = 1.57-6.80, and age: OR = 1.02, 95%CI = 1.00-1.04. Analysis of the subgroup of patients with septic shock showed that the odds ratio of furosemide was 5.5 (95%CI = 1.16-26.02) for development of AKI. Age, use of furosemide, and septic shock were predictors of AKI in critically ill patients. Use of furosemide in the subgroup of patients with sepsis/septic shock increased (68.4%) the chance of development of AKI when compared to the sample as a whole (43.9%)
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Affiliation(s)
- T M Levi
- Departamento de Ciências da Saúde, Universidade Estadual de Santa Cruz, Ilhéus, BA, Brasil
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Heise D, Gries D, Moerer O, Bleckmann A, Quintel M. Predicting restoration of kidney function during CRRT-free intervals. J Cardiothorac Surg 2012; 7:6. [PMID: 22257468 PMCID: PMC3275482 DOI: 10.1186/1749-8090-7-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 01/18/2012] [Indexed: 11/19/2022] Open
Abstract
Background Renal failure is common in critically ill patients and frequently requires continuous renal replacement therapy (CRRT). CRRT is discontinued at regular intervals for routine changes of the disposable equipment or for replacing clogged filter membrane assemblies. The present study was conducted to determine if the necessity to continue CRRT could be predicted during the CRRT-free period. Materials and methods In the period from 2003 to 2006, 605 patients were treated with CRRT in our ICU. A total of 222 patients with 448 CRRT-free intervals had complete data sets and were used for analysis. Of the total CRRT-free periods, 225 served as an evaluation group. Twenty-nine parameters with an assumed influence on kidney function were analyzed with regard to their potential to predict the restoration of kidney function during the CRRT-free interval. Using univariate analysis and logistic regression, a prospective index was developed and validated in the remaining 223 CRRT-free periods to establish its prognostic strength. Results Only three parameters showed an independent influence on the restoration of kidney function during CRRT-free intervals: the number of previous CRRT cycles (medians in the two outcome groups: 1 vs. 2), the "Sequential Organ Failure Assessment"-score (means in the two outcome groups: 8.3 vs. 9.2) and urinary output after the cessation of CRRT (medians in two outcome groups: 66 ml/h vs. 10 ml/h). The prognostic index, which was calculated from these three variables, showed a satisfactory potential to predict the kidney function during the CRRT-free intervals; Receiver operating characteristic (ROC) analysis revealed an area under the curve of 0.798. Conclusion Restoration of kidney function during CRRT-free periods can be predicted with an index calculated from three variables. Prospective trials in other hospitals must clarify whether our results are generally transferable to other patient populations.
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Affiliation(s)
- Daniel Heise
- Department of Anesthesiology, Emergency and Critical Care Medicine, University Hospital Göttingen, Germany.
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Zhu Q, Xia M, Wang Z, Li PL, Li N. A novel lipid natriuretic factor in the renal medulla: sphingosine-1-phosphate. Am J Physiol Renal Physiol 2011; 301:F35-41. [PMID: 21478479 DOI: 10.1152/ajprenal.00014.2011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Sphingosine-1-phosphate (S1P) is a bioactive sphingolipid metabolite formed by phosphorylation of sphingosine. S1P has been indicated to play a significant role in the cardiovascular system. It has been shown that the enzymes for S1P metabolism are expressed in the kidneys. The present study characterized the expression of S1P receptors in the kidneys and determined the role of S1P in the control of renal hemodynamics and sodium excretion. Real-time RT-PCR analyses showed that S1P receptors S1P1, S1P2, and S1P3 were most abundantly expressed in the renal medulla. Immunohistochemistry revealed that all three types of S1P receptors were mainly located in collecting ducts. Intramedullary infusion of FTY720, an S1P agonist, produced a dramatic increase in sodium excretion by twofold and a small but significant increase in medullary blood flow (16%). Administration of W146, an S1P1 antagonist, into the renal medulla blocked the effect of FTY720 and decreased the sodium excretion by 37% when infused alone. The antagonists of S1P2 and S1P3 had no effect. FTY720 produced additive natriuretic effects in combination with different sodium transporter inhibitors except amiloride, an epithelial sodium channel blocker. In the presence of nitric oxide synthase inhibitor l-NAME, FTY720 still increased sodium excretion. These data suggest that S1P produces natriuretic effects via activation of S1P1 in the renal medulla and this natriuretic effect may be through inhibition of epithelial sodium channel, which is nitric oxide independent. It is concluded that S1P is a novel diuretic factor in the renal medulla and may be an important regulator of sodium homeostasis.
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Affiliation(s)
- Qing Zhu
- Dept. of Pharmacology and Toxicology, Medical College of Virginia Campus, Virginia Commonwealth University, PO Box 980613, Richmond, VA 23298, USA
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Aravindan N, Shaw A. Effect of Furosemide Infusion on Renal Hemodynamics and Angiogenesis Gene Expression in Acute Renal Ischemia/Reperfusion. Ren Fail 2009; 28:25-35. [PMID: 16526316 DOI: 10.1080/08860220500461229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Loop diuretics are known to affect renal hemodynamics and possibly gene transcription, but the specific effect of furosemide on renal angiogenesis gene expression after acute ischemia is not known. We utilized an acute renal failure model in rats to test the hypothesis that furosemide improves renal hemodynamics and alters the transcriptional signature of acute ischemic nephropathy. Twenty-four male Sprague-Dawley rats were anesthetized by the intraperitoneal administration of 50 mg/kg urethane. Animals were divided into four groups (n = 6 each): (1) sham-operated group infused with saline; (2) sham-operated group infused with 30 microg/kg/hr furosemide (equivalent to a human dosage of 2 mg/hr); (3) unilateral renal ischemia (1 hr, left renal artery cross-clamping) followed by 6 hr of reperfusion; and (4) renal ischemia/ reperfusion (I/R) with furosemide. Renal artery blood flow (RBF), renal cortical perfusion (RCP), and renal corticomedullary tissue oxygen tension (PO2) were recorded throughout. Following 6 hr of reperfusion, left kidney RNA was used to probe microarrays. Gene expression was measured as percent positive control and confirmed using reverse transcriptase polymerase chain reaction. Physiologic data were analyzed by calculating area under the curve, and gene expression data were compared by using multiple analysis of variance with Tukey's post-hoc tests. Furosemide significantly increased RBF (P < 0.05) and PO2 (P < 0.05) in postischemic kidneys. Furosemide attenuated nine of the 13 ischemia-induced and 41 of 78 ischemia-suppressed angiogenesis-related genes. This attenuation was statistically significant (P < 0.05) for 17 I/R injury-suppressed genes. Data from this rat model of ischemic nephropathy suggest that furosemide improves renal hemodynamics and attenuates ischemia-related changes in gene expression.
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Affiliation(s)
- Natarajan Aravindan
- Division of Cardiothoracic Anesthesia and Critical Care Medicine, Duke University, Durham, North Carolina, USA.
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Oppermann M, Hansen PB, Castrop H, Schnermann J. Vasodilatation of afferent arterioles and paradoxical increase of renal vascular resistance by furosemide in mice. Am J Physiol Renal Physiol 2007; 293:F279-87. [PMID: 17494095 DOI: 10.1152/ajprenal.00073.2007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Loop diuretics like furosemide have been shown to cause renal vasodilatation in dogs and humans, an effect thought to result from both a direct vascular dilator effect and from inhibition of tubuloglomerular feedback. In isolated perfused afferent arterioles preconstricted with angiotensin II or N(G)-nitro-L-arginine methyl ester, furosemide caused a dose-dependent increase of vascular diameter, but it was without effect in vessels from NKCC1-/- mice suggesting that inhibition of NKCC1 mediates dilatation in afferent arterioles. In the intact kidney, however, furosemide (2 mg/kg iv) caused a 50.5 +/- 3% reduction of total renal blood flow (RBF) and a 27% reduction of superficial blood flow (SBF) accompanied by a marked and immediate increase of tubular pressure and volume. At 10 mg/kg, furosemide reduced RBF by 60.4 +/- 2%. Similarly, NKCC1-/- mice responded to furosemide with a 45.4% decrease of RBF and a 29% decrease of SBF. Decreases in RBF and SBF and increases of tubular pressure by furosemide were ameliorated by renal decapsulation. In addition, pretreatment with candesartan (2 mg/kg) or indomethacin (5 mg/kg) attenuated the reduction of RBF and peak urine flows caused by furosemide. Our data indicate that furosemide, despite its direct vasodilator potential in isolated afferent arterioles, causes a marked increase in flow resistance of the vascular bed of the intact mouse kidney. We suggest that generation of angiotensin II and/or a vasoconstrictor prostaglandin combined with compression of peritubular capillaries by the expanding tubular compartment are responsible for the reduction of RBF in vivo.
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Affiliation(s)
- Mona Oppermann
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Pedersen M, Vajda Z, Stødkilde-Jørgensen H, Nielsen S, Frøkiaer J. Furosemide increases water content in renal tissue. Am J Physiol Renal Physiol 2007; 292:F1645-51. [PMID: 17264309 DOI: 10.1152/ajprenal.00060.2006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study was designed to evaluate the short-term effects of intravenous administration of furosemide on key functions in the kidney cortex and the outer and inner medulla of rats by using magnetic resonance imaging (MRI). Renal tissue water content, renal tissue oxygenation (in relation to the magnetic resonance spin-spin relaxation rate), the apparent diffusion coefficient (ADC) of water, and volume of renal blood flow were measured. Furosemide administration resulted in an increased water content in all regions of the kidney. In parallel with this, we found a significant reduction in ADC in the cortex (2.7 +/- 0.1 x 10(-3) to 2.3 +/- 0.1 x 10(-3) mm(2)/s; P < 0.01) and in the outer medulla (2.3 +/- 0.1 x 10(-3) to 2.0 +/- 0.1 x 10(-3) mm(2)/s; P < 0.01), indicating that the intra- to extracellular volume fraction of water increased in response to furosemide administration. Furosemide also decreased the blood oxygenation in the cortex (49.1 +/- 2.9 to 40.9 +/- 2.0 s(-1); P < 0.01), outer medulla (41.9 +/- 2.8 to 33.2 +/- 1.6 s(-1); P < 0.01) and in the inner medulla (37.1 +/- 2.9 to 26.7 +/- 1.8 s(-1); P < 0.01), indicating an increased amount of oxygenated Hb in the renal tissue. Moreover, renal blood flow decreased in response to furosemide (6.9 +/- 0.2 to 4.4 +/- 0.2 ml/min; P < 0.001). In conclusion, furosemide administration was associated with increased renal water content, an increase in the intra- to extracellular volume fraction of water, an increased oxygen tension, and a decrease in the renal blood flow. Thus MRI provides an integrated evaluation of changes in renal function, leading to decreased renal water and solute reabsorption in response to furosemide, and, in addition, MRI provides an alternative tool to monitor noninvasively changes at the cellular level.
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Affiliation(s)
- Michael Pedersen
- MR Research Centre, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark
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Pedersen M, Dissing TH, Mørkenborg J, Stødkilde-Jørgensen H, Hansen LH, Pedersen LB, Grenier N, Frøkiaer J. Validation of quantitative BOLD MRI measurements in kidney: application to unilateral ureteral obstruction. Kidney Int 2005; 67:2305-12. [PMID: 15882272 DOI: 10.1111/j.1523-1755.2005.00334.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Blood oxygenation level dependent (BOLD) magnetic resonance imaging (MRI) provides a measure of deoxyhemoglobin content and therefore an indirect measure of the partial oxygen pressure (pO(2)). The main purpose of this study was to examine the relationship between the apparent relaxation rate (R2*) in the pig kidney by BOLD imaging and renal tissue pO(2) levels measured directly by oxygen-sensitive microelectrodes. Second, BOLD imaging was applied to kidneys in pigs subjected to acute unilateral ureteral obstruction (UUO) to examine whether this condition is associated with changes in intrarenal oxygenation. METHODS Oxygen-sensitive microelectrodes were inserted in the cortex and medulla of pig kidneys (N= 6). Different arterial and intrarenal levels of pO(2) were obtained by stepwise changing the oxygen-to-nitrogen ratio supplied by a respirator. Simultaneous BOLD MRI measurements using an R2*-sensitive Echo Planar Imaging (EPI) sequence were performed on the contralateral kidney. In another group of pigs (N= 3) BOLD imaging was performed following 24 hours of UUO. RESULTS When the inhaled oxygen fraction was 5% to 70%, R2* was linearly related to pO(2) levels (cortex DeltaR2*/DeltapO(2)=-1.2 ms(-1)kPa(-1), and medulla DeltaR2*/DeltapO2 =-1.7 ms(-1)kPa(-1)). Twenty-four hours of UUO was associated with an increased R2* in the cortex and a decreased R2* in medulla as compared with baseline, which remained augmented after the release of UUO, indicating that pO(2) levels were reduced in the cortex and increased in the medulla during and after release of obstruction. CONCLUSION BOLD MRI provides noninvasive estimates of regional renal oxygen content and our study demonstrates that this technique may provide a useful tool in UUO which is associated with altered renal oxygen consumption.
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Affiliation(s)
- Michael Pedersen
- MR Research Centre, Clinical Institute, Aarhus University, Aarhus, Denmark.
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Dobrowolski L, Sadowski J. Furosemide-induced renal medullary hypoperfusion in the rat: role of tissue tonicity, prostaglandins and angiotensin II. J Physiol 2005; 567:613-20. [PMID: 15961422 PMCID: PMC1474203 DOI: 10.1113/jphysiol.2005.090027] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Furosemide (frusemide)-induced renal medullary hypoperfusion provides a model for studies of the dependence of local circulation on tissue tonicity. We examined the role of medullary prostaglandins (PG) and adenosine (Ado) as possible mediators of the response to furosemide. Furosemide was infused i.v. at 0.25 mg kg(-1) h(-1) in anaesthetized rats, untreated or treated with intramedullary indomethacin (Indo) or Ado. An integrated set-up was used to measure renal medullary laser-Doppler flux (MBF) and medullary ionic tonicity (electrical admittance, Y), and to infuse Indo and Ado directly into the medulla. The cortical flux was measured on kidney surface. The excretion of water, sodium and total solute was also determined. Intramedullary Indo (1 mg kg(-1) h(-1)) decreased MBF 18 +/- 5% and increased tissue Y 14 +/- 3% (both significant); the treatment abolished the post-furosemide decrease in MBF (-22% in untreated group) and enhanced slightly the increase in renal excretion. Intramedullary Ado (5 mg kg(-1) h(-1)) did not change baseline MBF or Y; the post-furosemide decreases in MBF (-22%) and Y, and the increase in renal excretion were preserved. We conclude that a decrease in intramedullary PG activity secondary to decreased medullary hypertonicity mediates the fall in medullary perfusion in response to furosemide; the hypoperfusion may help restore the initial tonicity. Together with the earlier evidence on the dependence of post-furosemide medullary hypoperfusion on angiotensin II, the study exposes its interaction with PG in the control of medullary circulation. Adenosine is not involved in medullary vascular responses to decreased tissue hypertonicity.
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Affiliation(s)
- Leszek Dobrowolski
- Laboratory of Renal Physiology, M. Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.
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