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Erschienen in: Intensive Care Medicine 1/2005

01.01.2005 | Original

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

verfasst von: Kristina Swärd, Felix Valsson, Johan Sellgren, Sven-Erik Ricksten

Erschienen in: Intensive Care Medicine | Ausgabe 1/2005

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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 51Cr-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.
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Metadaten
Titel
Differential effects of human atrial natriuretic peptide and furosemide on glomerular filtration rate and renal oxygen consumption in humans
verfasst von
Kristina Swärd
Felix Valsson
Johan Sellgren
Sven-Erik Ricksten
Publikationsdatum
01.01.2005
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 1/2005
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2490-3

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