Renal Vasodilatory Action of Arginine Vasopressin in Extremely Low Birth Weight Infants

Abstract

In extremely low birth weight (ELBW) infants, systemic hypotension is associated with poor neurological outcomes as a result of cerebral hypoperfusion. Treatment with arginine vasopressin (AVP) has been shown to increase blood pressure (BP) and urine output in ELBW infants suffering from refractory hypotension. The purpose of this study was to clarify whether low doses of AVP increased renal blood flow (RBF) in ELBW infants. We retrospectively analyzed data from the medical charts describing nine AVP infusions at 0.3-0.8 mU/kg/min in four ELBW infants. The median gestational age was 23 (22.5-23.5, interquartile range) weeks, and the median birth weight was 466 (414-563) g. Changes in the heart rate, BP, urine output, and RBF velocity patterns in response to the AVP infusions were compared using statistical analyses. The AVP infusion caused significant increases in systolic BP from 44 (41.0-47.0) to 50 (42.5-55.5) mmHg, diastolic BP from 17 (15.0-26.5) to 31 (28.5-33.0) mmHg, mean BP from 26 (24.5-30.5) to 36 (34.5-40.5) mmHg, and urine output from 1.4 (0.2-2.5) to 2.8 (1.0-8.6) mL/kg/hr. We also observed significant decreases in the resistance index from 1.0 (0.96-1.0) to 0.8 (0.71-0.91) and peak systolic flow velocity in the renal artery from 40 (27.2-50.6) to 28 (16.0-28.9) cm/s after AVP infusions. AVP infusions at 0.3-0.8 mU/kg/min in ELBW infants appeared to significantly increase the RBF by inducing renal vascular dilation and increasing the BP. Increasing the RBF most likely induces an increase in the glomerular filtration rate, resulting in the diuretic effect of AVP.Keywords: arginine vasopressin; diuretic effect; extremely low birth weight infants; renal blood flow; renal vasodilation Tohoku J. Exp. Med., 2013 November, 231 (3), 159-164.

Terlipressin‐induced modifications of Doppler ultrasound signals of systemic arteries in preterm infants with vasoactive‐resistant patent ductus arteriosus: A pilot study

“…However, similar doses were successfully used in other ELBW infants not enrolled in this study cohort (data not shown) and have been reported as effective in improving renal function, both in the experimental model and in the critically ill patient . TP‐induced modifications of the Doppler blood flow signal in the renal artery (Figure , bottom) support the hypothesis that TP may enhance renal perfusion by increasing mean arterial blood pressure and renal vascular dilation in the ELBW infants with hs‐PDA, as previously theorized for arginine vasopressin (AVP) . TP is a synthetic analogue of AVP presented as a specific vasopressin 1a receptor (V1a‐R) agonist, although its full V1b‐R and V2‐R agonism has been recently suggested.…”

“…26,27 TP-induced modifications of the Doppler blood flow signal in the renal artery (Figure 2, bottom) support the hypothesis that TP may enhance renal perfusion by increasing mean arterial blood pressure and renal vascular dilation in the ELBW infants with hs-PDA, as previously theorized for arginine vasopressin (AVP). 28 TP is a synthetic analogue of AVP presented as a specific vasopressin 1a receptor (V1a-R) agonist, although its full V1b-R and V2-R agonism 29 has been recently suggested. We suppose that TP may preserve glomerular perfusion and filtration in infants with hs-PDA by the complex interplay between selective V1-R stimulation of the extrarenal vasculature, vasodilation of the afferent arterioles, and intrarenal shift of blood flow to the cortex.…”

Dopamine and Neonatal Pulmonary Hypertension—Pressing Need for a Better Pressor?

“…It is important to recognize that this adaptation often is associated with a brisk urine output that may occur rapidly and requires careful observation. 40,43 Close monitoring of salt and water balance and serum electrolytes is recommended.…”

Efficacy and Safety of Vasopressin and Terlipressin in Preterm Neonates: A Systematic Review

“…Twelve studies described the use of AVP for the treatment of hypotension in 144 neonates (219 episodes) [18,[28][29][30][31][32][33][34][35]38,39,41], with median (minimum, maximum) gestational age (GA) and postnatal age (PNA) of 26 (23,36) days, respectively. AVP was a rescue treatment in 10 studies (134 neonates, 199 episodes, 93%).…”