Urodilatin: a new approach for the treatment of therapy‐resistant acute renal failure after liver transplantation

Abstract

Abstract.A pilot study was performed in patients after liver transplantation (Ltx) to examine the effect of continuous intravenous urodilatin (URO, CDD/ ANP-95-126)-infusion as an alternative therapy of acute renal failure (ARF) resistant to conventional therapy. Eight patients who developed ARF after liver transplantation and fulfilled requirements for haemodialysis/haemofiltration were treated. After URO infusion was started, renal function improved and all patients developed a strong diuresis and natriuresis within 2-4 h. The extracellular expansion due to sodium and water retention in anuric/oliguric ARF lead to an increased central venous pressure (CVP) and elevated blood pressure. During the URO infusion CVP declined and systolic, as well as diastolic, blood pressure were stable. In six patients where haemodialysis/haemofiltration could be avoided, serum creatinine (SC) and blood urea nitrogen (BUN) declined during URO treatment and creatinine clearance (CC) also improved significantly. Fluid and electrolyte disturbances changed promptly and normalized. This was in concordance with renal excretion of electrolytes. Two patients still required haemodialysisfhaemofiltration. The six patients who did not require haemodialysis/haemofiltration after URO treatment normalized concerning their renal function and did well in a control period of 12 weeks. The study shows that continuous low dose URO infusion may present a new concept for treatment of postoperative acute renal failure resistant to conventional therapy.Keywords. Acute renal failure, cardiodilatin/atrial natriuretic peptide (CDD/ANP-99-126), liver transplantation, urodilatin (URO, CDD/ANP-95-126).

Atrial Natriuretic Peptide for Management of Acute Kidney Injury

“…Excluding 142 nonrelevant titles and abstracts, we retrieved 29 studies in complete form and assessed them according to the selection criteria. A total of 10 studies were further excluded for the following reasons: six lacked a control group (11)(12)(13)(14)(15)(16), three lacked randomization process (17)(18)(19), and one included participants on chronic RRT before the initiation of study (20). Our analysis finally identified 19 eligible studies that included 1861 participants (1021 ANP group, 840 control Figure 1.…”

Heme Oxygenase-1 Is a cGMP-Inducible Endothelial Protein and Mediates the Cytoprotective Action of Nitric Oxide

“…This is the first time that ANP has been linked to HO-1 expression. Beyond a generally improved defense against oxidant injury, induction of an anti-inflammatory protein by activators of particulate guanylyl cyclase may have specific clinical implications because (1) ANP and related compounds reduce drug-induced nephrotoxicity in transplant recipients, 46,47 and (2) increased HO-1 expression is considered to protect against the chronic rejection of transplants. 19 -21 In the present study, however, HO-1 induction by hours.…”

Radiocontrast‐induced natriuresis associated with increased urinary urodilatin excretion

“…Since the urinary excretion of urodilatin correlates with the excretion of sodium, urodilatin may be a particularly effective therapeutic substance in oliguric, sodium-retentive states such as radiocontrast-induced nephropathy. To our knowledge urodilatin has not been used as a therapeutic/prophylactic agent in the clinical management of radiocontrastinduced nephropathy, but the intravenous administration of synthetic urodilatin was beneficial in patients with various other forms of acute oliguric renal failure [23][24][25].…”