Cedidi C, Meyer M, Kuse E R, Schulz-Knappe P, Ringe B, Frei U, Pichlmayr R, Forssmann W G
Niedersächsisches Institut für Peptid-Forschung (IPF), Medizinischen Hochschule Hannover, Germany.
Eur J Clin Invest. 1994 Sep;24(9):632-9. doi: 10.1111/j.1365-2362.1994.tb01116.x.
A pilot study was performed in patients after liver transplantation (Ltx) to examine the effect of continuous intravenous urodilatin (URO, CDD/ANP-95-126)-infusion as an alternative therapy of acute renal failure (ARF) resistant to conventional therapy. Eight patients who developed ARF after liver transplantation and fulfilled requirements for haemodialysis/haemofiltration were treated. After URO infusion was started, renal function improved and all patients developed a strong diuresis and natriuresis within 2-4 h. The extracellular expansion due to sodium and water retention in anuric/oliguric ARF lead to an increased central venous pressure (CVP) and elevated blood pressure. During the URO infusion CVP declined and systolic, as well as diastolic, blood pressure were stable. In six patients where haemodialysis/haemofiltration could be avoided, serum creatinine (SC) and blood urea nitrogen (BUN) declined during URO treatment and creatinine clearance (CC) also improved significantly. Fluid and electrolyte disturbances changed promptly and normalized. This was in concordance with renal excretion of electrolytes. Two patients still required haemodialysis/haemofiltration. The six patients who did not require haemodialysis/haemofiltration after URO treatment normalized concerning their renal function and did well in a control period of 12 weeks. The study shows that continuous low dose URO infusion may present a new concept for treatment of postoperative acute renal failure resistant to conventional therapy.
开展了一项针对肝移植（Ltx）术后患者的初步研究，以检验持续静脉输注尿舒张素（URO，CDD/ANP - 95 - 126）作为对传统治疗耐药的急性肾衰竭（ARF）替代疗法的效果。对8例肝移植术后发生ARF且符合血液透析/血液滤过要求的患者进行了治疗。开始输注URO后，肾功能改善，所有患者在2 - 4小时内出现强力利尿和利钠作用。无尿/少尿型ARF中因钠和水潴留导致的细胞外液量增加，致使中心静脉压（CVP）升高和血压上升。在输注URO期间，CVP下降，收缩压和舒张压均保持稳定。在6例可避免血液透析/血液滤过的患者中，URO治疗期间血清肌酐（SC）和血尿素氮（BUN）下降，肌酐清除率（CC）也显著改善。液体和电解质紊乱迅速改变并恢复正常。这与肾脏对电解质的排泄情况一致。2例患者仍需进行血液透析/血液滤过。6例在URO治疗后无需血液透析/血液滤过的患者肾功能恢复正常，并且在12周的对照期内情况良好。该研究表明，持续低剂量输注URO可能为治疗对传统治疗耐药的术后急性肾衰竭提供一种新的治疗理念。
