Furosemide Prevents Apoptosis and Associated Gene Expression in a Rat Model of Surgical Ischemic Acute Renal Failure

Aravindan, Natarajan; Aravindan, Sheeja; Riedel, Bernhard; Weng, Han‐Rong; Shaw, Andrew

doi:10.1080/08860220701263671

Cited by 40 publications

(20 citation statements)

References 31 publications

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“…Loop diuretics have effects that could be potentially beneficial in preventing or minimizing the severity of AKI. They reduce the oxygen demand and prevent hypoxic damage, and furosemide has been shown to improve renal hemodynamics, attenuate ischemic-related renal angiogenesis and reduce ischemic-induced apoptosis in animal models [39-41]. A pilot phase II randomized, blinded, placebo-controlled trial comparing furosemide to placebo in ICU patients with early AKI is in progress [42]; this study aims to compare the efficacy and safety of furosemide versus placebo on the progression of AKI severity and fluid balance.…”

Section: Discussionmentioning

confidence: 99%

Fluid balance and urine volume are independent predictors of mortality in acute kidney injury

et al. 2013

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IntroductionIn ICUs, both fluid overload and oliguria are common complications associated with increased mortality among critically ill patients, particularly in acute kidney injury (AKI). Although fluid overload is an expected complication of oliguria, it remains unclear whether their effects on mortality are independent of each other. The aim of this study is to evaluate the impact of both fluid balance and urine volume on outcomes and determine whether they behave as independent predictors of mortality in adult ICU patients with AKI.MethodsWe performed a secondary analysis of data from a multicenter, prospective cohort study in 10 Italian ICUs. AKI was defined by renal sequential organ failure assessment (SOFA) score (creatinine >3.5 mg/dL or urine output (UO) <500 mL/d). Oliguria was defined as a UO <500 mL/d. Mean fluid balance (MFB) and mean urine volume (MUV) were calculated as the arithmetic mean of all daily values. Use of diuretics was noted daily. To assess the impact of MFB and MUV on mortality of AKI patients, multivariate analysis was performed by Cox regression.ResultsOf the 601 included patients, 132 had AKI during their ICU stay and the mortality in this group was 50%. Non-surviving AKI patients had higher MFB (1.31 ± 1.24 versus 0.17 ± 0.72 L/day; P <0.001) and lower MUV (1.28 ± 0.90 versus 2.35 ± 0.98 L/day; P <0.001) as compared to survivors. In the multivariate analysis, MFB (adjusted hazard ratio (HR) 1.67 per L/day, 95%CI 1.33 to 2.09; <0.001) and MUV (adjusted HR 0.47 per L/day, 95%CI 0.33 to 0.67; <0.001) remained independent risk factors for 28-day mortality after adjustment for age, gender, diabetes, hypertension, diuretic use, non-renal SOFA and sepsis. Diuretic use was associated with better survival in this population (adjusted HR 0.25, 95%CI 0.12 to 0.52; <0.001).ConclusionsIn this multicenter ICU study, a higher fluid balance and a lower urine volume were both important factors associated with 28-day mortality of AKI patients.

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Section: Discussionmentioning

confidence: 99%

Fluid balance and urine volume are independent predictors of mortality in acute kidney injury

et al. 2013

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“…Interestingly, in rat kidneys, furosemide induces the number of autophagosomes in the thick ascending loop of Henle, but not in proximal tubular cells. 49 The autophagystimulating properties could partially explain the conflicting results regarding the use of furosemide in rat IRI models subjected to unilateral versus bilateral clamping; after unilateral IRI, furosemide improves outcomes and decreases apoptosis, 66,67 whereas it increases kidney function and lethality in a bilateral renal IRI model. 68 Based on our hypothesis on the dual role of autophagy depending on the extent of the ischemic stress, furosemide-induced autophagy will therefore more likely induce detrimental autophagy after bilateral, with higher IRI, than unilateral clamping.…”

Section: Modulation Of Autophagy In Renal Iri With Diuretics and Immumentioning

confidence: 92%

Autophagy and the Kidney: Implications for Ischemia-Reperfusion Injury and Therapy

Decuypere

Ceulemans

Agostinis³

et al. 2015

American Journal of Kidney Diseases

117

100

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“…The independent effect of diuretics on kidney function and overall prognosis in AKI is difficult to assess. Although animal models of ischemia/reperfusion-induced AKI have shown that low-dose furosemide can have a protective role on kidney function [29], a large prospective multicenter study suggested an increased risk of death and/or nonrecovery of kidney function with the use of loop diuretics [30]. The deleterious effect of diuretics on mortality was not confirmed by another similar larger study [31].…”

Section: Can Fluid Overload Impair Kidney Function?mentioning

confidence: 97%

Fluid accumulation and acute kidney injury: consequence or cause

Bouchard

Mehta

2009

Current Opinion in Critical Care

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Furosemide Prevents Apoptosis and Associated Gene Expression in a Rat Model of Surgical Ischemic Acute Renal Failure

Cited by 40 publications

References 31 publications

Fluid balance and urine volume are independent predictors of mortality in acute kidney injury

Fluid balance and urine volume are independent predictors of mortality in acute kidney injury

Autophagy and the Kidney: Implications for Ischemia-Reperfusion Injury and Therapy

Fluid accumulation and acute kidney injury: consequence or cause

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