Diuretics in Acute Kidney Injury

Nigwekar, Sagar U.; Waikar, Sushrut S.

doi:10.1007/978-1-4939-8628-6_20

Cited by 3 publications

(5 citation statements)

References 37 publications

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“…4,10 Despite its wide use, to date, no randomized clinical trials support its use in veterinary patients with AKI. 9 Our study suggests that some of the attributed effects of mannitol might not be of clinical relevance. For example, urine production significantly increased after mannitol administration, but the increase was not different from that achieved after an equivalent volume of D5W, suggesting that the diuretic effect resulted mostly from administration of fluids rather than from mannitol itself.…”

Section: Discussionmentioning

confidence: 72%

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Sequential changes in urine production, glomerular filtration rate, and electrolyte excretion after mannitol administration

Segev

Stafford

Kirby

et al. 2019

Veterinary Internal Medicne

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Introduction Acute kidney injury (AKI) leading to severe uremia is associated with high morbidity and mortality. Mannitol is an osmotic diuretic, widely used in the management of AKI, both as a bolus injection and as a constant rate infusion (CRI). Objectives To determine the plasma concentration of mannitol after a bolus injection and CRI at the recommended dosages, and to assess the effect of mannitol on renal function variables including urine production, glomerular filtration rate (GFR), and solute excretion. Methods Prospective cross‐over design study, using 6 healthy dogs. Each dog underwent 3 protocols with at least a 7‐day washout period between protocols. The first protocol included bolus injection of mannitol, the second protocol included bolus injection followed by CRI of mannitol and the third protocol (control) included injection of 5% dextrose in water (D5W). Urine production, GFR, and fractional excretion (FE) of solutes were measured for 10 hours. Results For all protocols, urine production significantly ( P < .001) increased after bolus injection, but no significant difference in urine production or GFR was observed among the treatment groups. Mannitol injection increased the FE of sodium and urea nitrogen, but these effects were short ‐ lived. Conclusions Mannitol has minimal effect on urine production and GFR but does increase FE of urea nitrogen and sodium, immediately after bolus injection. Constant rate infusion at a conventional dosage of 1 mg/kg/min cannot maintain these effects in dogs with normal renal function, because mannitol concentration decreases rapidly.

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Section: Discussionmentioning

confidence: 72%

“…4 Potential beneficial effects of its use include increases in glomerular filtration rate (GFR), renal blood flow, and tubular flow. 9,10 Mannitol also is a free radical scavenger and may facilitate elimination of selected uremic toxins by interfering with their reabsorption from the renal tubules to the peritubular capillaries.…”

mentioning

confidence: 99%

Sequential changes in urine production, glomerular filtration rate, and electrolyte excretion after mannitol administration

Segev

Stafford

Kirby

et al. 2019

Veterinary Internal Medicne

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“…Traditional Chinese medicine monomer has many advantages, such as higher biological activity and less toxic side effects compared with traditional Chinese medicine and synthetic compounds. However, relevant clinical trials have not been successful so far 2,26 …”

Section: Discussionmentioning

confidence: 99%

“…However, relevant clinical trials have not been successful so far. 2,26 SCU is a flavonoid compound isolated from natural plants, such as Scutellaria baicalensis Georgi and Scutellaria barbata D.Don with multiple biological functions including anti-inflammation, anti-oxidation, anti-apoptosis, and myocardial protection. 8 SCU has been used in cardiovascular and cerebrovascular diseases and inflammation-related diseases.…”

Section: Discussionmentioning

confidence: 99%

Scutellarin alleviates renal ischemia–reperfusion injury by inhibiting the MAPK pathway and pro‐inflammatory macrophage polarization

Deng,

Zheng,

Dou

et al. 2024

The FASEB Journal

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Renal ischemia–reperfusion injury (IRI) is an integral process in renal transplantation, which results in compromised graft survival. Macrophages play an important role in both the early inflammatory period and late fibrotic period in response to IRI. In this study, we investigated whether scutellarin (SCU) could protect against renal IRI by regulating macrophage polarization. Mice were given SCU (5–50 mg/kg) by gavage 1 h earlier, followed by a unilateral renal IRI. Renal function and pathological injury were assessed 24 h after reperfusion. The results showed that administration of 50 mg/kg SCU significantly improved renal function and renal pathology in IRI mice. In addition, SCU alleviated IRI‐induced apoptosis. Meanwhile, it reduced macrophage infiltration and inhibited pro‐inflammatory macrophage polarization. Moreover, in RAW 264.7 cells and primary bone marrow‐derived macrophages (BMDMs) exposed to SCU, we found that 150 μM SCU inhibited these cells to polarize to an inflammatory phenotype induced by lipopolysaccharide (LPS) and interferon‐γ (IFN‐γ). However, SCU has no influence on anti‐inflammatory macrophage polarization in vivo and in vitro induced by in interleukin‐4 (IL‐4). Finally, we explored the effect of SCU on the activation of the mitogen‐activated protein kinase (MAPK) pathway both in vivo and in vitro. We found that SCU suppressed the activation of the MAPK pathway, including the extracellular signal‐regulated kinase (ERK), Jun N‐terminal kinase (JNK), and p38. Our results demonstrated that SCU protects the kidney against IRI by inhibiting macrophage infiltration and polarization toward pro‐inflammatory phenotype via the MAPK pathway, suggesting that SCU may be therapeutically important in treatment of IRI.

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“…Diuretics have a limited role in managing heart and kidney involvement in septic patients (97). Renal replacement therapy with continuous renal replacement therapy should be promptly started (94).…”

Section: Management Of Crs-5mentioning

confidence: 99%

Type-5 Cardiorenal Syndrome (CRS-5): An up to Date

Lullo

Ronco

Cozzolino

et al. 2017

Nephrology @ Point of Care

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Cardiorenal syndromes (CRS) involve disorders of the heart or kidney whereby one organ dysfunction leads to the dysfunction of another. Five types of CRS are defined. While the first 4 types describe acute/chronic cardiorenal or renocardiac syndromes, type-5 CRS refers to secondary CRS or cardiorenal involvement in systemic conditions and describes the concomitant presence of renal and cardiovascular dysfunction. Type-5 CRS is a recently defined clinical syndrome and complete epidemiological data on this entity are still lacking. In the following review, epidemiological, pathophysiological, clinical, and therapeutic approaches to type-5 CRS will be discussed according to more recent findings.

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Diuretics in Acute Kidney Injury

Cited by 3 publications

References 37 publications

Sequential changes in urine production, glomerular filtration rate, and electrolyte excretion after mannitol administration

Sequential changes in urine production, glomerular filtration rate, and electrolyte excretion after mannitol administration

Scutellarin alleviates renal ischemia–reperfusion injury by inhibiting the MAPK pathway and pro‐inflammatory macrophage polarization

Type-5 Cardiorenal Syndrome (CRS-5): An up to Date

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