Differential effects of human atrial natriuretic peptide and furosemide on glomerular filtration rate and renal oxygen consumption in humans

• Published in: Intensive care medicine 2005, Vol.31 (1), p.79-85
• Main Authors: SWÄRD, Kristina, VALSSON, Felix, SELLGREN, Johan, RICKSTEN, Sven-Erik
• Format: Article
• Language: English
• Subjects: Acute; Acute Kidney Injury - prevention & control; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Atrial Natriuretic Factor; Atrial Natriuretic Factor - pharmacology; Atrial Natriuretic Factor - therapeutic use; Biological and medical sciences; Blood coagulation. Blood cells; Blood Pressure; Blood Pressure - drug effects; Care and treatment; Case studies; Coronary Artery Bypass; Diseases of the respiratory system; Diuretics; Diuretics - pharmacology; Diuretics - therapeutic use; drug effects; Female; Fundamental and applied biological sciences. Psychology; Furosemide; Furosemide - pharmacology; Furosemide - therapeutic use; General aspects, investigation methods, hemostasis, fibrinolysis; Glomerular Filtration Rate; Glomerular Filtration Rate - drug effects; Humans; Intensive care medicine; Kidney; Kidney - drug effects; Kidney - metabolism; Kidney Failure; Male; MEDICAL AND HEALTH SCIENCES; Medical sciences; MEDICIN OCH HÄLSOVETENSKAP; metabolism; Middle Aged; Molecular and cellular biology; Oxygen Consumption; Oxygen Consumption - drug effects; pharmacology; Postoperative Complications; Postoperative Complications - prevention & control; prevention & control; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Renal Circulation; Renal Circulation - drug effects; Risk factors; Sodium; Sodium - metabolism; Statistics; therapeutic use
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-004-2490-3

Imbalance in the renal medullary oxygen supply/demand relationship can cause hypoxic medullary damage and ischemic acute renal failure. Human atrial natriuretic peptide (h-ANP) increases glomerular filtration rate in clinical acute renal failure. This would increase renal oxygen consumption due to increased tubular load of sodium. Loop diuretics are commonly used in acute renal failure. Data on the effects of loop diuretics on glomerular filtration rate and renal oxygen consumption in humans are, however, controversial. We evaluated the effects of h-ANP and furosemide on renal oxygen consumption, glomerular filtration rate, and renal hemodynamics in humans. Prospective two-agent interventional study in a university hospital cardiothoracic ICU. Nineteen uncomplicated, mechanically ventilated postcardiac surgery patients with normal renal function. h-ANP (25 and 50 ng/kg per minute, n=10) or furosemide (0.5 mg/kg per hour, n=9). Renal plasma flow and glomerular filtration rate were measured using the infusion clearance technique for (51)Cr-labeled EDTA and paraaminohippurate, corrected for by renal extraction of PAH. h-ANP increased glomerular filtration rate, renal filtration fraction, fractional excretion of sodium, and urine flow. This was accompanied by an increase in tubular sodium reabsorption (9%) and renal oxygen consumption (26%). Furosemide infusion caused a 10- and 15-fold increase in urine flow and fractional excretion of sodium, respectively, accompanied by a decrease in tubular sodium reabsorption (-28%), renal oxygen consumption (-23%), glomerular filtration rate and filtration fraction (-12% and -7%, respectively). The filtered load of sodium is an important determinant of renal oxygen consumption. h-ANP improves glomerular filtration rate but does not have energy-conserving tubular effects. In contrast, furosemide decreases tubular sodium reabsorption and renal oxygen consumption and thus has the potential to improve the oxygen supply/demand relationship in clinical ischemic acute renal failure.