Fenoldopam Mesylate: A Narrative Review of Its Use in Acute Kidney Injury

Abstract

Background: Fenoldopam mesylate is a selective agonist of DA-1 receptors. It is currently used for the in-hospital treatment of severe hypertension. DA-1 receptors have high density in renal parenchyma and for this reason, a possible reno-protective role of Fenoldopam mesylate was investigated. Method: We examined all studies regarding the role of Fenoldopam mesylate in Acute Kidney Injury (AKI); particularly, those involving post-surgical patients, intensive care unit patients and contrastinduced nephropathy. Results: Fenoldopam mesylate was found to be effective in reducing the onset of postoperative AKI, when used before the development of the kidney damage. Positive results were also obtained in the management of intensive care unit patients with AKI, although the clinical studies investigated were few and conducted on small samples. Conclusion: Conflicting results were achieved in contrast-induced nephropathy.

Future insights of pharmacological prevention for AKI post cardiopulmonary bypass surgery (based on PK/PD approach)

“…While the peripheral dopamine-1 receptor sites are located on blood vessels, renal tubules, and juxtaglomerular cells. At low doses, fenoldopam has a direct effect on the renal tubules which it has ability to produce natriuresis and diuresis ( Ricci and Ronco, 2006 ) and at the renal dose, fenoldopam has no any systemic effects ( Ricci and Ronco, 2006 ; Noce et al, 2019 ). In a small study, it was shown that fenoldopam exerted positive result by increasing blood flow in all renal compartments and the amelioration of renal blood flow produced in starting from a dose of 0.1–0.3 μg/kg/min with stable hemodynamic conditions of patients and preserved renal function ( Meco and Cirri, 2010 ).…”

“…Administration of fenoldopam did not provide any benefit to patient which may experience deterioration in mean arterial pressure during cardiac surgery and in the presence of insufficient of renal function. Thereby the use of fenoldopam is appropriate for the prevention strategy of postoperative AKI ( Meco and Cirri, 2010 ; Noce et al, 2019 ).…”

Ultramicronized Palmitoylethanolamide (um-PEA): A New Possible Adjuvant Treatment in COVID-19 patients

“…From autopsy reports performed in the city of Wuhan, microscopic examination of the kidney revealed that AKI was induced by acute tubular necrosis, characterized by lumen dilation, vascular degeneration, and alteration of the tubular epithelium [ 121 , 125 ].…”

Understanding the Molecular Crosstalk in Biological Processes

“…The blockade of either estrogen-induced (liganded) or unliganded activation of ERs provoked a strong compensatory upregulation on the unaffected domain, while the unbalanced ER activation resulted in modest or even adverse tumor responses and severe toxic symptoms [114]. In contrast, natural estrogens are capable of restoring DNA surveillance even in tumor cells leading to a self-directed death through a balanced liganded and unliganded transactivation of ERs, whereas they may not provoke genomic instability even in sky-high concentrations [115].…”

“…This study did not examine the impact induced by the body surface area on CV protection. Therefore, calcium antagonists emerge as a pharmaceutical alternative in the treatment of obesity-related hypertension with potential benefits [113], even if more clinical randomized trials are required to fully understand their beneficial effects [114,115].…”