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Title: Furosemide reverses medullary tissue hypoxia in ovine septic acute kidney injury.
Austin Authors: Iguchi, Naoya;Lankadeva, Yugeesh R;Mori, Trevor A;Osawa, Eduardo A;Cutuli, Salvatore L ;Evans, Roger G;Bellomo, Rinaldo ;May, Clive N
Affiliation: Preclinical Critical Care Unit, The Florey Institute of Neuroscience and Mental Health, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Australia
School of Medicine and Pharmacology, University of Western Australia
Univ. of Melbourne, Melbourne, Australia
Issue Date: 2019
Date: 2019-05-29
Publication information: American journal of 2019; 317(2): R232-R239
Abstract: In experimental sepsis, the rapid development of renal medullary hypoxia precedes the development of acute kidney injury (AKI) and may contribute to its pathogenesis. We investigated whether inhibiting active sodium transport and oxygen consumption in the medullary thick ascending limb with furosemide attenuates the medullary hypoxia in experimental septic AKI. Sheep were instrumented with flow probes on the pulmonary and renal arteries, and fiber optic probes to measure renal cortical and medullary perfusion and oxygen tension (PO2). Sepsis and AKI were induced by infusion of live E. coli. At 24 h of sepsis there were significant decreases in renal medullary tissue perfusion (1332±233 to 698±159 blood perfusion units) and PO2 (44±6 to 19±6 mmHg) (both p < 0.05). By 5 min after intravenous administration of furosemide (20 mg) renal medullary PO2 increased to 43±6 mmHg and remained at this normal level for 8 h. Furosemide caused transient increases in fractional excretion of sodium and creatinine clearance, but medullary perfusion, renal blood flow and renal oxygen delivery were unchanged. Urinary F2-isoprostanes, an index of oxidative stress, were not significantly changed at 24 h of sepsis, but tended to transiently decrease after furosemide treatment. In septic AKI, furosemide rapidly restored medullary PO2 to pre-septic levels. This effect was not accompanied by changes in medullary perfusion or renal oxygen delivery but was accompanied by a transient increase in fractional sodium excretion, implying decreased oxygen consumption as a mechanism.
DOI: 10.1152/ajpregu.00371.2018
ORCID: 0000-0002-1650-8939
Journal: American journal of physiology. Regulatory, integrative and comparative physiology
PubMed URL: 31141418
Type: Journal Article
Subjects: Acute kidney injury
septic shock
Appears in Collections:Journal articles

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