Additive diuretic response of concurrent aminophylline and furosemide in children: a case series and a brief literature review

Abstract

Aminophylline exerts a renovascular effect, acting by adenosine receptor blockade or type IV phosphodiesterase inhibition. Clinically, these drugs have been used with furosemide to induce diuresis in adults and neonates. However, reports on use of aminophylline in diuretic-dependent children are limited to a few studies. We report a case series of four critically ill children unresponsive to furosemide continuous infusion who were subsequently given aminophylline as an adjunct diuretic in the treatment of fluid overload. No side effects were evident. Administration of aminophylline at low doses (3 mg/kg) successfully promoted increased urine output over the 6-h study period in all four children.

Xanthine Derivatives for Kidney Protection in the Critically Ill Pediatric Population: A Systematic Review

“…Adenosine-mediated vasoconstriction decreases blood flow through the glomerulus, promoting increased solute concentration. 1 Xanthine derivative inhibition of adenosine-mediated renal vasoconstriction causes increase in renal blood flow, thus, increasing glomerular filtration rate. This also leads to an increase in creatinine clearance and urine output as identified in this meta-analysis.…”

“…A total of 6 studies were pooled for the analyses of creatinine clearance. 1,3,6,9,11,15 This resulted in a total of 67 patients. Not all studies described how creatinine clearance was calculated.…”

“…A total of seven studies were pooled for the analyses of urine output. 1,3,5,6,8,13,14 This resulted in a total of 54 patients. Urine collection varies from one study to another, but the majority of the studies collected urine hourly for a total of 6 to 12 hours.…”

“…Aggressive fluid resuscitation may lead to fluid overload that is associated with increased morbidity and mortality in this patient population. 1,2 Although diuretics remain one of the mainstay therapies for fluid overload, these agents may be associated with decreased creatinine clearance, electrolyte disturbances, and effect failure due to diuretic resistance.…”

“…[2][3][4][5] The precise mechanism by which xanthine derivatives have a diuretic effect has not been completely elucidated, but it appears to promote renal vascular vasodilation through adenosine receptor blockade and inhibition of cyclic nucleotide phosphodiesterase activity. 1,2,6 The purpose of this meta-analysis was to assess the effects of xanthine derivatives (theophylline and aminophylline) on fluid balance and renal function in critically ill children.…”