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VOLUME 21 , ISSUE 7 ( 2017 ) > List of Articles


The Effect of Furosemide on the Level of Neutrophil Gelatinase-Associated Lipocalin in Critically Hospitalized Patients with Acute Kidney Injury

Hadi Hamishehkar, Vahid Fattahi, Mehran Mesgari

Keywords : Acute kidney injury, furosemide, Intensive Care Unit, plasma neutrophil gelatinase-associated lipocalin, urine neutrophil gelatinase-associated lipocalin

Citation Information : Hamishehkar H, Fattahi V, Mesgari M. The Effect of Furosemide on the Level of Neutrophil Gelatinase-Associated Lipocalin in Critically Hospitalized Patients with Acute Kidney Injury. Indian J Crit Care Med 2017; 21 (7):442-447.

DOI: 10.4103/ijccm.IJCCM_93_17

License: CC BY-ND 3.0

Published Online: 01-07-2018

Copyright Statement:  Copyright © 2017; The Author(s).


Background and Aims: Oliguric acute kidney injury (AKI), commonly attributed to a more severe degree of renal injury, is associated with poorer prognosis than nonoliguric form. The aim of this study was to determine the effect of furosemide therapy on kidney function and on the level of neutrophil gelatinase-associated lipocalin (NGAL) in critically hospitalized patients in the Intensive Care Unit (ICU). Materials and Methods: In this randomized controlled trial, 106 ICU patients with AKI were assigned into furosemide and control groups. In furosemide group, 40–80 mg of intravenous furosemide was administrated, followed by 1–5 mg/h furosemide infusion. In control group, patients received standard treatment. Serum and urinary NGAL were measured on the 1st, 3rd, and 7th days of the study. Results: The results of this study indicated that during the study, serum blood urea nitrogen levels of patients increased in both groups; this, however, was significant only in the control group (P = 0.009). Both plasma and urine NGAL decreased significantly (P < 0.05) in both groups. The findings of 28-day mortality follow-up revealed that 20% and 28% of patients died in the furosemide and the control groups, respectively. Conclusions: NGAL was not found to reflect any positive or negative effects of Furosemide in patients with AKI.

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  1. Kellum JA, Bellomo R, Ronco C. The concept of acute kidney injury and the RIFLE criteria. Contrib Nephrol 2007;156:10-6.
  2. Mehta RL, Cantarovich F, Shaw A, Hoste E, Murray P. Pharmacologic approaches for volume excess in acute kidney injury (AKI). Int J Artif Organs 2008;31:127-44.
  3. Mehta RL. Fluid balance and acute kidney injury: The missing link for predicting adverse outcomes? Nat Clin Pract Nephrol 2009;5:10-1.
  4. Bagshaw SM, Brophy PD, Cruz D, Ronco C. Fluid balance as a biomarker: Impact of fluid overload on outcome in critically ill patients with acute kidney injury. Crit Care 2008;12:169.
  5. Uchino S, Doig GS, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Diuretics and mortality in acute renal failure. Crit Care Med 2004;32:1669-77.
  6. Lassnigg A, Donner E, Grubhofer G, Presterl E, Druml W, Hiesmayr M. Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol 2000;11:97-104.
  7. Cantarovich F, Rangoonwala B, Lorenz H, Verho M, Esnault VL; High-Dose Flurosemide in Acute Renal Failure Study Group. High-dose furosemide for established ARF: A prospective, randomized, double-blind, placebo-controlled, multicenter trial. Am J Kidney Dis 2004;44:402-9.
  8. Mehta RL, Pascual MT, Soroko S, Chertow GM; PICARD Study Group. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002;288:2547-53.
  9. Swärd K, Valsson F, Sellgren J, Ricksten SE. Differential effects of human atrial natriuretic peptide and furosemide on glomerular filtration rate and renal oxygen consumption in humans. Intensive Care Med 2005;31:79-85.
  10. Ho KM, Sheridan DJ. Meta-analysis of frusemide to prevent or treat acute renal failure. BMJ 2006;333:420.
  11. Rastogi S, Bayliss JM, Nascimento L, Arruda JA. Hyperkalemic renal tubular acidosis: Effect of furosemide in humans and in rats. Kidney Int 1985;28:801-7.
  12. Lee CT, Chen HC, Lai LW, Yong KC, Lien YH. Effects of furosemide on renal calcium handling. Am J Physiol Renal Physiol 2007;293:F1231-7.
  13. Zhang Z, Lu B, Sheng X, Jin N. Cystatin C in prediction of acute kidney injury: A systemic review and meta-analysis. Am J Kidney Dis 2011;58:356-65.
  14. Damman K, Ng Kam Chuen MJ, MacFadyen RJ, Lip GY, Gaze D, Collinson PO, et al. Volume status and diuretic therapy in systolic heart failure and the detection of early abnormalities in renal and tubular function. J Am Coll Cardiol 2011;57:2233-41.
  15. Makris K, Markou N, Evodia E, Dimopoulou E, Drakopoulos I, Ntetsika K, et al. Urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury in critically ill multiple trauma patients. Clin Chem Lab Med 2009;47:79-82.
  16. Zappitelli M, Washburn KK, Arikan AA, Loftis L, Ma Q, Devarajan P, et al. Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: A prospective cohort study. Crit Care 2007;11:R84.
  17. Wheeler DS, Devarajan P, Ma Q, Harmon K, Monaco M, Cvijanovich N, et al. Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock. Crit Care Med 2008;36:1297-303.
  18. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative Workgroup. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204-12.
  19. Bagshaw SM, Delaney A, Jones D, Ronco C, Bellomo R. Diuretics in the management of acute kidney injury: A multinational survey. Contrib Nephrol 2007;156:236-49.
  20. Cotter G, Weissgarten J, Metzkor E, Moshkovitz Y, Litinski I, Tavori U, et al. Increased toxicity of high-dose furosemide versus low-dose dopamine in the treatment of refractory congestive heart failure. Clin Pharmacol Ther 1997;62:187-93.
  21. van der Voort PH, Boerma EC, Koopmans M, Zandberg M, de Ruiter J, Gerritsen RT, et al. Furosemide does not improve renal recovery after hemofiltration for acute renal failure in critically ill patients: A double blind randomized controlled trial. Crit Care Med 2009;37:533-8.
  22. Bagshaw SM, Delaney A, Haase M, Ghali WA, Bellomo R. Loop diuretics in the management of acute renal failure: A systematic review and meta-analysis. Crit Care Resusc 2007;9:60-8.
  23. Hanley MJ, Davidson K. Prior mannitol and furosemide infusion in a model of ischemic acute renal failure. Am J Physiol 1981;241:F556-64.
  24. Escalante B, Erlij D, Falck JR, McGiff JC. Effect of cytochrome P450 arachidonate metabolites on ion transport in rabbit kidney loop of Henle. Science 1991;251:799-802.
  25. Heyman SN, Rosen S, Epstein FH, Spokes K, Brezis ML. Loop diuretics reduce hypoxic damage to proximal tubules of the isolated perfused rat kidney. Kidney Int 1994;45:981-5.
  26. Liangos O, Perianayagam MC, Vaidya VS, Han WK, Wald R, Tighiouart H, et al. Urinary N-acetyl-beta-(D)-glucosaminidase activity and kidney injury molecule-1 level are associated with adverse outcomes in acute renal failure. J Am Soc Nephrol 2007;18:904-12.
  27. Bagshaw SM, Langenberg C, Wan L, May CN, Bellomo R. A systematic review of urinary findings in experimental septic acute renal failure. Crit Care Med 2007;35:1592-8.
  28. Cruz DN, Soni S, Ronco C. NGAL and cardiac surgery-associated acute kidney injury. Am J Kidney Dis 2009;53:565-6.
  29. Nickolas TL, O'Rourke MJ, Yang J, Sise ME, Canetta PA, Barasch N, et al. Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med 2008;148:810-9.
  30. Mishra J, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 2003;14:2534-43.
  31. Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005;365:1231-8.
  32. Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A; NGAL Meta-analysis Investigator Group. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: A systematic review and meta-analysis. Am J Kidney Dis 2009;54:1012-24.
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