Medical University of South Carolina, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Department of Medicine, Veterans Affairs Medical Center, San Diego, CA, USA.
Ren Fail. 2021 Dec;43(1):830-839. doi: 10.1080/0886022X.2021.1906701.
Loop diuretics are among the most widely used drugs worldwide and are commonly employed in the management of complications associated with acute kidney injury (AKI), namely volume overload and electrolyte management. The use of loop diuretics in critically ill patients with AKI is paramount to preventing or treating pulmonary edema. The naturetic response to a loop diuretic is based on its unique renal pharmacology. Our review article summarizes the pharmacology of furosemide in the intact nephron and discusses how this response might be altered by the presence of AKI. We discuss the increasing body of literature on the latest clinical utility of furosemide namely, it's challenge test, known as the furosemide stress test which has highlighted a new and novel role for furosemide over the past number of years. This test assists with the identification of AKI subjects at higher risk of AKI progression and the need for renal replacement therapy. The stress test can also predict cessation of continuous renal replacement therapy in patients with established AKI. On the basis of the evidence presented in this review, we propose future potential studies of furosemide in AKI.
袢利尿剂是全球应用最广泛的药物之一，常用于治疗急性肾损伤（AKI）相关并发症，如容量超负荷和电解质管理。在 AKI 的危重症患者中使用袢利尿剂对于预防或治疗肺水肿至关重要。袢利尿剂的利钠肽反应基于其独特的肾脏药理学。我们的综述文章总结了呋塞米在完整肾单位中的药理学，并讨论了 AKI 对这种反应的可能影响。我们讨论了越来越多的关于呋塞米最新临床应用的文献，即它的挑战试验，即呋塞米应激试验，该试验在过去几年中突出了呋塞米的一个新的、新颖的作用。该试验有助于确定 AKI 患者中 AKI 进展和需要肾脏替代治疗的风险较高的患者。应激试验还可以预测已确诊 AKI 患者连续肾脏替代治疗的停止。基于本综述中提出的证据，我们提出了未来在 AKI 中对呋塞米进行研究的建议。
