Potent diuretic effects of prednisone in heart failure patients with refractory diuretic resistance

Abstract

The present study demonstrated that prednisone can rapidly eliminate volume overload and improve clinical status and renal function in CHF patients with diuretic resistance. Further prospective randomized clinical studies are warranted to confirm its clinical efficacy.

Prednisone Adding to Usual Care Treatment for Refractory Decompensated Congestive Heart Failure

“…Also, glucocorticoids may promote natriuretic peptide excretion and upregulate their receptors in kidney, thus demonstrating a natriuretic peptide sensitizer-like effect. 6,8) However, a drawback is that diuresis induced by prednisone is time-dependent, ie, there is, usually a lag time of 3 days for prednisone, as we described previously, before its effects are exerted in patients with heart failure. Of note, adding prednisone to conventional care resulted in reductions in serum creatinine and uric acid, and slight increases in BUN.…”

“…In previous studies, we found that prednisone had potent diuretic effects in patients with stable congestive heart failure, and could restore renal function and elicit potent diuretic effects even in heart failure patients with refractory diuretic resistance. [6][7][8] Thus, prednisone may be a new drug candidate for patients with DCHF.…”

Glucocorticoids Improve Renal Responsiveness to Atrial Natriuretic Peptide by Up-Regulating Natriuretic Peptide Receptor-A Expression in the Renal Inner Medullary Collecting Duct in Decompensated Heart Failure

“…In heart patients with severe fluid retention, glucocorticoids could induced potent diuretic effect and restore fluid hemostasis (Liu et al, 2006(Liu et al, , 2007Zhang et al, 2008;Massari et al, 2011). Recently, we demonstrated that glucocorticoids even produced potent diuresis in rats with overnight water deprivation (Liu et al, 2010).…”

“…Contrary to the notion that glucocorticoids cause renal water and sodium retention, evidence showed glucocorticoid administration could produce potent diuresis and natriuresis in rats (Thunhorst et al, 2007;Liu et al, 2010). It has also been found, in clinical observations, that chronic glucocorticoid administration could produce potent diuresis and restore body fluid homeostasis in patients with heart failure and severe fluid overload (Liu et al, 2006(Liu et al, , 2007Zhang et al, 2008;Massari et al, 2011). Previous evidence showed that glucocorticoids could up-regulate ANP mRNA expression in the atrial myocytes and increase ANP levels in the circulation (Gardner et al, 1988;Dananberg and Grekin, 1992).…”

Efeito da dexametasona e melatonina exógenas sobre parâmetros sanguíneos, progesterona, carboidratos totais e histomorfometria de órgãos em ratas prenhes

“…Sabe-se que os glicocorticoides exercem efeitos sobre o mecanismo de homeostase dos fluidos corporais, provocando alterações, como redução da volemia e aumento da osmolalidade do sangue (Ruginsk et al, 2007). Postula-se que a administração aguda ou crônica de glicocorticoides pode levar, respectivamente, ao aumento ou redução da diurese e natriurese (Liu et al, 2007), além de promover alterações no citoesqueleto das células (Aru et al, 2013). Assim, a variação no percentual de hematócrito pode estar relacionada a uma disfunção renal, levando no início a um quadro de desidratação, causa mais comum de aumento do hematócrito (Ribeiro Filho et al, 2011), e, no período final, a um possível quadro de anemia (Bejarano et al, 2003).…”