Immediate effects of furosemide on renal hemodynamics in chronic liver disease with ascites.
Immediate effects of furosemide on renal hemodynamics in chronic liver disease with ascites.
复制标题
速尿对慢性肝病腹水肾血流动力学的直接影响。
DOI：
10.1016/0016-5085(87)90616-0
复制
发表时间：
1987
期刊：
影响因子：
29.4
通讯作者：
Zipser,RD
中科院分区：
文献类型：
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作者：
Daskalopoulos,G;Laffi,G;Morgan,T;Pinzani,M;Harley,H;Reynolds,T;Zipser,RD
速尿有时会导致腹水患者出现氮质血症，与引起的容量减少无关。为了确定这种效应，我们测量了慢性肝病腹水患者和非腹水对照患者的肾脏清除率。呋塞米（80 mg 静脉注射）暂时增加了对照组（从 693 ± 67 至 928 ± 93 ml/min）和 11 名腹水患者（从 418 ± 81 至 526 ± 80 ml/min）的β-氨基马尿酸清除率。相比之下，在 13 名腹水患者中，β-氨基马尿酸清除率在 20 分钟内下降了 34%（从 545 ± 51 降至 360 ± 24 ml/min），在 60 分钟内下降了 41%，菊粉清除率在 20 分钟时下降了 19%，在 60 分钟时下降了 30%。肾脏影响持续约4小时。肾脏反应无法通过肾素活性、尿前列腺素排泄物、尿钠或临床特征来预测。在所有接受口服呋塞米的 14 名患者中，p-氨基马尿酸清除率在 90 分钟内下降（下降了 24%），并保持抑制至少 4 小时。呋塞米对肾灌注的直接影响可能导致某些腹水患者出现氮质血症。
Furosemide occasionally causes azotemia in patients with ascites, independently of induced volume depletion. To define this effect, we measured renal clearances in patients with chronic liver disease and ascites and in nonascitic controls. Furosemide (80 mg i.v.) transiently increasedp-aminohippurate clearance in controls (from 693 ± 67 to 928 ± 93 ml/min) and in 11 patients with ascites (from 418 ± 81 to 526 ± 80 ml/min). In contrast, in 13 patients with ascites,p-aminohippurate clearance fell by 34% (from 545 ± 51 to 360 ± 24 ml/min) within 20 min and by 41% within 60 min, and inulin clearance fell by 19% at 20 min and by 30% at 60 min. The renal effects lasted ~4 h. The renal response could not be predicted by renin activity, urinary prostaglandin excretion, urinary sodium, or clinical characteristics. In all 14 patients who received oral furosemide,p-aminohippurate clearance fell within 90 min (by 24%) and remained suppressed for at least 4 h. These immediate effects of furosemide on renal perfusion may contribute to azotemia in some patients with ascites.