Pharmacologic approaches for volume excess in acute kidney injury (AKI)

The Effect of Furosemide on the Level of Neutrophil Gelatinase-associated Lipocalin in Critically Hospitalized Patients with Acute Kidney Injury

BACKGROUND AND AIMS

Oliguric acute kidney injury (AKI), commonly attributed to a more severe degree of renal injury, is associated with poorer prognosis than nonoliguric form. The aim of this study was to determine the effect of furosemide therapy on kidney function and on the level of neutrophil gelatinase-associated lipocalin (NGAL) in critically hospitalized patients in the Intensive Care Unit (ICU).

MATERIALS AND METHODS

In this randomized controlled trial, 106 ICU patients with AKI were assigned into furosemide and control groups. In furosemide group, 40-80 mg of intravenous furosemide was administrated, followed by 1-5 mg/h furosemide infusion. In control group, patients received standard treatment. Serum and urinary NGAL were measured on the 1^st, 3^rd, and 7^th days of the study.

RESULTS

The results of this study indicated that during the study, serum blood urea nitrogen levels of patients increased in both groups; this, however, was significant only in the control group (P = 0.009). Both plasma and urine NGAL decreased significantly (P < 0.05) in both groups. The findings of 28-day mortality follow-up revealed that 20% and 28% of patients died in the furosemide and the control groups, respectively.

CONCLUSIONS

NGAL was not found to reflect any positive or negative effects of Furosemide in patients with AKI.

Effect of Fenoldopam Continuous Infusion on Glomerular Filtration Rate and Fractional Excretion of Sodium in Healthy Dogs

BACKGROUND

Acute kidney injury (AKI) is a common problem in small-animal patients and carries a guarded prognosis with substantial morbidity and mortality, particularly in oligoanuric dogs. Fenoldopam, a selective dopamine agonist, has been shown to increase urine output in healthy dogs and cats; however, the mechanism of action is unknown.

HYPOTHESIS/OBJECTIVES

To evaluate the effect of fenoldopam infusion on glomerular filtration rate (GFR) and fractional excretion of sodium (FeNa) in healthy dogs.

ANIMALS

Ten healthy, privately owned dogs.

METHODS

Randomized, crossover design with negative control. Ten healthy dogs were given fenoldopam diluted in 5% dextrose (D5W) as a continuous IV infusion of 0.8 μg/kg/min for 5 hours and a control infusion of D5W alone, 7 days apart. Glomerular filtration rate was measured by exogenous iohexol clearance, beginning 1 hour after the start of the fenoldopam infusion. Fractional excretion of sodium (FeNa) was measured before and after the infusion. Glomerular filtration rate and change in FeNa were compared between treatment days.

RESULTS

Fenoldopam infusion resulted in a significantly increased (P = .0166) GFR (median GFR, 3.33 mL/min/kg) in healthy dogs compared with D5W infusion (median GFR, 2.71 mL/kg/min). Fenoldopam also resulted in a significantly increased (P = .0148) FeNa (mean change, 0.106), whereas infusion of D5W alone did not (mean change, 0.016).

CONCLUSIONS AND CLINICAL IMPORTANCE

In healthy dogs, fenoldopam significantly increased GFR and FeNa compared with infusion of D5W alone. No adverse effects were seen.