Dopamine and Frusemide in Oliguric Acute Renal Failure

Abstract

Into 24 oliguric patients with acute renal failure (ARF) for whom mannitol and high-dose frusemide had failed to promote a diuresis, dopamine (3 μg/kg/min) plus frusemide (10–15 mg/kg/h) were infused for 6–24 h. In 19 of the 24 patients this treatment produced significant increases in diuresis (from 11 ± 7 to 85 ± 51 ml/h; p < 0.001) and natriuresis (from 45 ± 13 to 88 ± 22 mEq/l; p < 0.001), without any significant modification of blood pressure, pulse rate or central venous pressure. 10 of the 24 patients required dialysis: 5 because therapy failed to promote diuresis and the other 5 because of their hypercatabolic state in spite of polyuria. 5 patients died of causes unrelated to ARF. Since all patients who responded were treated within 24 h after the onset of oliguria, it appears to be crucial to administer dopamine and frusemide early, before more severe anatomical and functional damage develops.

Use of Urinary Parameters in the Diagnosis of Total Acute Renal Artery Occlusion

“…In our experience, UNa above 100 mEq/1 and FENa above 30% are almost never seen in cases of acute tubular necrosis [12][13][14][15][16][17], High FENa and urinary parameters similar to those observed by us in patients with total A RAO are sometimes found in patients with obstructive ARE [12,13,19], However, only 1 patient with nondilated bilateral ureteral obstruction showed this urinary pattern during the 13.5 years of this study. Exceptionally high UNa concentra tions had been found after extremely high doses of diuretics and dopamine [20].…”

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“…6 Because of its specific renal effects, low-dose dopamine has been used to treat cases of suspected renal hypoperfusion and vasoconstriction, 2 factors involved in renal dysfunction and acute tubular necrosis. [7][8][9][10][11][12][13] Vasoconstriction after ischemiareperfusion in kidney transplant has been proposed to explain posttransplant kidney dysfunction. 14 Although infusion of a "renal dopamine dose" has been suggested to provide better renal tissue perfusion and better preservation of transplant function, so far, there is no clinical evidence either for or against this strategy.…”

Effect of low-dose dopamine on the pharmacokinetics of tobramycin in dogs

“…Low-dose dopamine (0.5 to 3.0 jig/kg per min) has been shown to increase the glomerular filtration rate and increase urine output (8, 10). Acute oliguric renal failure occurs commonly during gram-negative sepsis, and low-dose dopamine has been used in this setting in an attempt to convert oliguric renal failure to nonoliguric renal failure (8,10,12).This study was designed to test the hypothesis that lowdose dopamine will increase the CL of tobramycin. We elected to perform a study in animals to assess whether further human investigation is necessary, since the pharmacokinetics of the aminoglycosides and the pharmacology of dopamine are similar in humans and canines (1,8,15).…”

“…Low-dose dopamine (0.5 to 3.0 jig/kg per min) has been shown to increase the glomerular filtration rate and increase urine output (8, 10). Acute oliguric renal failure occurs commonly during gram-negative sepsis, and low-dose dopamine has been used in this setting in an attempt to convert oliguric renal failure to nonoliguric renal failure (8,10,12).…”

“…and was continued until the end of the sample collections. Blood samples (7 ml) were drawn just before and at 1,5,10, 20, 40, 60, 90, 120, 150, 180, and 210 min after the tobramycin dose. The blood samples were allowed to clot in serum separator tubes and were centrifuged for 10 min.…”