Differential effects of human atrial natriuretic peptide and furosemide on glomerular filtration rate and renal oxygen consumption in humans

2.50
Hdl Handle:
http://hdl.handle.net/2336/65296
Title:
Differential effects of human atrial natriuretic peptide and furosemide on glomerular filtration rate and renal oxygen consumption in humans
Authors:
Swärd, Kristina; Valsson, Felix; Sellgren, Johan; Ricksten, Sven-Erik
Citation:
Intensive Care Med. 2005, 31(1):79-85
Issue Date:
1-Jan-2005
Abstract:
OBJECTIVE: Imbalance in the renal medullary oxygen supply/demand relationship can cause hypoxic medullary damage and ischemic acute renal failure. Human atrial natriuretic peptide (h-ANP) increases glomerular filtration rate in clinical acute renal failure. This would increase renal oxygen consumption due to increased tubular load of sodium. Loop diuretics are commonly used in acute renal failure. Data on the effects of loop diuretics on glomerular filtration rate and renal oxygen consumption in humans are, however, controversial. We evaluated the effects of h-ANP and furosemide on renal oxygen consumption, glomerular filtration rate, and renal hemodynamics in humans. DESIGN AND SETTING: Prospective two-agent interventional study in a university hospital cardiothoracic ICU. PATIENTS: Nineteen uncomplicated, mechanically ventilated postcardiac surgery patients with normal renal function. INTERVENTIONS: h-ANP (25 and 50 ng/kg per minute, n=10) or furosemide (0.5 mg/kg per hour, n=9). MEASUREMENTS AND RESULTS: Renal plasma flow and glomerular filtration rate were measured using the infusion clearance technique for (51)Cr-labeled EDTA and paraaminohippurate, corrected for by renal extraction of PAH. h-ANP increased glomerular filtration rate, renal filtration fraction, fractional excretion of sodium, and urine flow. This was accompanied by an increase in tubular sodium reabsorption (9%) and renal oxygen consumption (26%). Furosemide infusion caused a 10- and 15-fold increase in urine flow and fractional excretion of sodium, respectively, accompanied by a decrease in tubular sodium reabsorption (-28%), renal oxygen consumption (-23%), glomerular filtration rate and filtration fraction (-12% and -7%, respectively). CONCLUSIONS: The filtered load of sodium is an important determinant of renal oxygen consumption. h-ANP improves glomerular filtration rate but does not have energy-conserving tubular effects. In contrast, furosemide decreases tubular sodium reabsorption and renal oxygen consumption and thus has the potential to improve the oxygen supply/demand relationship in clinical ischemic acute renal failure.
Description:
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Full metadata record

DC FieldValue Language
dc.contributor.authorSwärd, Kristina-
dc.contributor.authorValsson, Felix-
dc.contributor.authorSellgren, Johan-
dc.contributor.authorRicksten, Sven-Erik-
dc.date.accessioned2009-04-17T14:55:23Z-
dc.date.available2009-04-17T14:55:23Z-
dc.date.issued2005-01-01-
dc.date.submitted2009-04-17-
dc.identifier.citationIntensive Care Med. 2005, 31(1):79-85en
dc.identifier.issn0342-4642-
dc.identifier.pmid15565364-
dc.identifier.doi10.1007/s00134-004-2490-3-
dc.identifier.urihttp://hdl.handle.net/2336/65296-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractOBJECTIVE: Imbalance in the renal medullary oxygen supply/demand relationship can cause hypoxic medullary damage and ischemic acute renal failure. Human atrial natriuretic peptide (h-ANP) increases glomerular filtration rate in clinical acute renal failure. This would increase renal oxygen consumption due to increased tubular load of sodium. Loop diuretics are commonly used in acute renal failure. Data on the effects of loop diuretics on glomerular filtration rate and renal oxygen consumption in humans are, however, controversial. We evaluated the effects of h-ANP and furosemide on renal oxygen consumption, glomerular filtration rate, and renal hemodynamics in humans. DESIGN AND SETTING: Prospective two-agent interventional study in a university hospital cardiothoracic ICU. PATIENTS: Nineteen uncomplicated, mechanically ventilated postcardiac surgery patients with normal renal function. INTERVENTIONS: h-ANP (25 and 50 ng/kg per minute, n=10) or furosemide (0.5 mg/kg per hour, n=9). MEASUREMENTS AND RESULTS: Renal plasma flow and glomerular filtration rate were measured using the infusion clearance technique for (51)Cr-labeled EDTA and paraaminohippurate, corrected for by renal extraction of PAH. h-ANP increased glomerular filtration rate, renal filtration fraction, fractional excretion of sodium, and urine flow. This was accompanied by an increase in tubular sodium reabsorption (9%) and renal oxygen consumption (26%). Furosemide infusion caused a 10- and 15-fold increase in urine flow and fractional excretion of sodium, respectively, accompanied by a decrease in tubular sodium reabsorption (-28%), renal oxygen consumption (-23%), glomerular filtration rate and filtration fraction (-12% and -7%, respectively). CONCLUSIONS: The filtered load of sodium is an important determinant of renal oxygen consumption. h-ANP improves glomerular filtration rate but does not have energy-conserving tubular effects. In contrast, furosemide decreases tubular sodium reabsorption and renal oxygen consumption and thus has the potential to improve the oxygen supply/demand relationship in clinical ischemic acute renal failure.en
dc.language.isoenen
dc.publisherSpringer Verlagen
dc.relation.urlhttp://www.springerlink.com/content/ag8nt8u2wtf801fken
dc.subject.meshAgeden
dc.subject.meshAtrial Natriuretic Factoren
dc.subject.meshBlood Pressureen
dc.subject.meshCoronary Artery Bypassen
dc.subject.meshDiureticsen
dc.subject.meshFemaleen
dc.subject.meshFurosemideen
dc.subject.meshGlomerular Filtration Rateen
dc.subject.meshHumansen
dc.subject.meshKidneyen
dc.subject.meshKidney Failure, Acuteen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshOxygen Consumptionen
dc.subject.meshPostoperative Complicationsen
dc.subject.meshRenal Circulationen
dc.subject.meshSodiumen
dc.titleDifferential effects of human atrial natriuretic peptide and furosemide on glomerular filtration rate and renal oxygen consumption in humansen
dc.typeArticleen
dc.contributor.departmentDepartment of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden.en
dc.identifier.journalIntensive care medicineen
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