Role of the Furosemide Stress Test in Renal Injury Prognosis

Abstract

Risk stratification and accurate patient prognosis are pending issues in the management of patients with kidney disease. The furosemide stress test (FST) has been proposed as a low-cost, fast, safe, and easy-to-perform test to assess tubular integrity, especially when compared to novel plasma and urinary biomarkers. However, the findings regarding its clinical use published so far provide insufficient evidence to recommend the generalized application of the test in daily clinical routine. Dosage, timing, and clinical outcomes of the FST proposed thus far have been significantly different, which further accentuates the need for standardization in the application of the test in order to facilitate the comparison of results between series. This review will summarize published research regarding the usefulness of the FST in different settings, providing the reader some insights about the possible implications of FST in clinical decision-making in patients with kidney disease and the challenges that research will have to address in the near future before widely applying the FST.

Machine learning model for predicting acute kidney injury progression in critically ill patients

“…Our model and previous FST studies have comparable prediction ability (AU-ROC 0.926 vs. 0.88). However, FST has some limitations including not stable for patients with unstable hemodynamics [ 7 ] and no standardization of dosage and time [ 8 ]. Our model is based on vital signs and laboratory data, which are easily assessable in most institutions.…”

“…Furosemide stress test (FST) was considered as a robust predictive approach to identify who will progress to AKI stage 3 [ 6 ]. However, the clinical application has been hampered for several reasons such as lacking of high quality RCT [ 5 ], not stable for patients with unstable hemodynamics [ 7 ], no standardization of dosage and time [ 8 ] and ambiguous effect of other factors such as fluid balance and diuretic on the outcome [ 9 ].…”

Commentary: Renal replacement therapy in cardiac surgery patients: An urgent need for consensus

“…Several mechanisms can induce renal dysfunction, including exogenous and endogenous toxins, inflammation, hemodynamic and oxidative stress, or ischemia-reperfusion injury. 2 Management of AKI is based on 3 key points: (1) treatment of the underlying causes of renal injury, if they have been identified and if such treatment is available; (2) avoiding further insult; and (3) offering supportive care. Although numerous pharmacologic approaches have been developed in the effort to find an effective therapy for AKI, none has been effectively translated into the real-world clinical setting.…”

“…Several mechanisms can induce renal dysfunction, including exogenous and endogenous toxins, inflammation, hemodynamic and oxidative stress, or ischemia-reperfusion injury. 2 …”

Editorial for Special Issue—Biomarkers of Renal Disease

“…Coca et al have revised the [15] furosemide stress test as a low-cost, fast, safe, and easy-to-perform test to assess tubular integrity, to allow for risk stratification and accurate patient prognosis in the management of patients with kidney disease. However, the findings published so far regarding its clinical use provide insufficient evidence to recommend the generalized application of the test in daily clinical routine, and they recommend the need for standardization in the application of the test in order to facilitate the comparison of results.…”