Intensive Care Medicine

, Volume 31, Issue 1, pp 79–85 | Cite as

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

  • Kristina Swärd
  • Felix Valsson
  • Johan Sellgren
  • Sven-Erik Ricksten
Original

Abstract

Objective

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.

Design and setting

Prospective two-agent interventional study in a university hospital cardiothoracic ICU

Patients

Nineteen uncomplicated, mechanically ventilated postcardiac surgery patients with normal renal function.

Interventions

h-ANP (25 and 50 ng/kg per minute, n=10) or furosemide (0.5 mg/kg per hour, n=9)

Measurements and results

Renal plasma flow and glomerular filtration rate were measured using the infusion clearance technique for 51Cr-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).

Conclusions

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.

Keywords

Human atrial natriuretic peptide Furosemide Glomerular filtration rate Renal oxygen consumption Sodium reabsorption 

Notes

Acknowledgements

The technical assistance of Marita Ahlqvist and the assistance of the nursing staff of the Cardiothoracic Intensive Care Unit and Surgical Theatre of the Sahlgrenska University Hospital are gratefully acknowledged.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Kristina Swärd
    • 1
  • Felix Valsson
    • 1
  • Johan Sellgren
    • 1
  • Sven-Erik Ricksten
    • 1
  1. 1.Department of Cardiothoracic Anesthesia and Intensive CareSahlgrenska University HospitalGothenburgSweden

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