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PubMed2006

Evaluation of furosemide regimens in neonates treated with extracorporeal membrane oxygenation.

INTRODUCTION: Loop diuretics are the most frequently used diuretics in patients treated with extracorporeal membrane oxygenation (ECMO). In patients after cardiopulmonary bypass (CPB) surgery, the use of continuous furosemide infusion is increasingly documented. Because ECMO and CPB are 'comparable' procedures, continuous furosemide infusion is used in newborns on ECMO. We report on the use of continuous intravenous furosemide in neonates treated with ECMO. METHODS: This was a retrospective observational study in neonates treated with continuous intravenous furosemide during ECMO. RESULTS: Thirty-one patients were included in the study. A median of 25 (9-149) hours after the start of ECMO, continuous furosemide therapy was started at a median rate of 0.08 (0.02-0.17) mg/kg per hour. The continuous furosemide dose was not changed in the individual patient. Seven patients received a furosemide bolus prior to, and five patients received additional loop diuretics during, the continuous infusion. Urine production before continuous furosemide therapy was not significantly different between patients who received a furosemide bolus prior to the infusion and those who did not receive this bolus (P = 0.2879). Although a positive effect of the 'loading' bolus was observed in urine output in the first 24 hours, there was no statistically significant difference in urine output (P = 0.0961) or in time (P = 0.1976) to reach a urine output of 6 ml/kg per hour between patients. After 24 hours, urine production remained a median of 6.2 ml/kg per hour irrespective of furosemide boluses. The forced diuresis was well tolerated as illustrated by stable haemodynamic parameters and a decrease in ECMO flow and vasopressor score over the observation period. CONCLUSION: This is the first report on continuous intravenous furosemide therapy in newborns treated with ECMO. The furosemide regimens used in this study varied widely in continuous and intermittent doses. However, all regimens achieved adequate urine output. An advantage of continuous, over intermittent, intravenous furosemide could not be documented. Furosemide dosing regimens should be developed for neonates treated with ECMO. In addition, therapeutic drug-monitoring studies are required to prevent furosemide toxicity because so far no data are available on serum furosemide levels in neonates treated with ECMO.

Diuretics↗

PubMed2000

Activation of renal afferent pathways following furosemide treatment. II. Effect Of angiotensin blockade.

The goal here and in the accompanying paper was to evaluate the two pathways used by the kidney to provide information to the central nervous system (CNS); e.g., the indirect, hormonal route via activation of the renin-angiotensin system and the direct pathway via activation of sympathetic afferents in the caudal thoracic spinal cord. Here, three experiments were designed to evaluate the actions of angiotensin elicited by subcutaneous injection of furosemide on neural activation of the CNS. The number of neurons immunocytochemically staining for the protein product (Fos) of the c-fos gene was used as an index of neuronal activation. In the first experiment, furosemide injection was preceded by treatment with a dose of Captopril, CAP, (an angiotensin-converting enzyme (ACE) inhibitor) that blocks the peripheral but not the central formation of angiotensin II. In the second experiment, furosemide injection was preceded by treatment with a higher dose of CAP; this dosage blocks the peripheral and central formation of angiotensin II. In the third experiment, furosemide injection was preceded by treatment with Losartan, a competitive receptor antagonist of type I angiotensin II receptors at a dose that would block central and peripheral angiotensin receptors. Control animals in each experiment received injections of vehicle (sterile isotonic saline) instead of furosemide. In each experiment, rats were sacrificed 1.75 h following furosemide or saline injection by transcardial perfusion and tissues were immunocytochemically processed for demonstration of Fos antigen. Rats receiving furosemide plus the low CAP dose showed more Fos-positive cells than control rats in the subfornical organ (SFO), organum vasculosum lamina terminalis (OVLT), supraoptic nucleus (SON), magnocellular region of the paraventricular nucleus, nucleus of the solitary tract (NTS), and caudal thoracic/rostral lumbar spinal cord dorsal horn. Rats receiving furosemide plus Losartan or furosemide plus the higher CAP dose did not show increased Fos immunoreactivity in any of the abovementioned structures relative to their respective control animals. We conclude that the receptor-mediated action of angiotensin II is in some way involved in the activation of the pathway that occurs in the SFO, OVLT, SON, and magnocellular region of the paraventricular nucleus (PVN) in response to furosemide treatment. It is possible that the furosemide-induced activation in the SON and PVN is not due to direct actions of angiotensin II on angiotensin receptors in those structures, but instead occurs synaptically as a result of inputs from the SFO and OVLT, which have themselves been activated directly by angiotensin II. In the accompanying paper, furosemide-induced activation in the NTS and caudal thoracic spinal cord is abolished by prior bilateral renal denervation, meaning that these neurons are likely part of a renal afferent pathway. Here, these structures did not elaborate Fos in animals injected with furosemide plus the high CAP dose or furosemide plus Losartan. Thus, the present results also suggest that the central blockade of the formation of angiotensin II or blockade of the actions of angiotensin II prevents in some way the activation of the renal afferent pathway mediated by the renal nerves (the direct pathway) in response to the actions of furosemide. Therefore, these results suggest that central angiotensin II is somehow involved in "priming" or increasing the sensitivity of the direct renal afferent pathway. Taken together with the accompanying paper, our results indicate that interruption of the direct pathway via renal denervation did not interfere with the elaboration of Fos in the lamina terminalis; in contrast, modification of the humoral renal afferent pathway can affect the sensitivity of the direct pathway. These results may have important implications for pathophysiological changes associated with fluid balance disorders including renal hypertension.

Afferent Pathways↗

PubMedDate not supplied

Micropuncture study of the effect of furosemide on proximal and distal tubules of the rat nephron.

The tubular effects of furosemide were studied by micropuncture and clearance techniques on 20 rats. Collections of tubular fluid (TF) from early distal (ED) and late proximal (LP) segments of the same nephrons and of different nephrons were performed during baseline conditions. Re-collections were taken from the same sites and new collections from different nephrons after 10 mg/kg furosemide. The glomerular filtration rate (GFR) was 1,309 +/- 212 microliters/min during baseline, and 1,348 +/- 199 microliters/min after furosemide (p > 0.89); while the urine flow rate rose from 36 +/- 8 to 167 +/- 30 microliters/min (p < 0.001). The nephron filtration rate (NFR) was not different in 46 paired distal (33.3 +/- 2.6 nl/min) versus proximal samples (34.2 +/- 2.9 nl/min, p > 0.72), neither was it different during baseline (37.2 +/- 1.4, n = 120) as compared to furosemide (37.2 +/- 2.7, n = 91, p > 0.99). The percent reabsorption (PR) at the ED sampling site was 87 +/- 4% during baseline, and 89 +/- 3% in 13 paired samples during furosemide (p > 0.47). PR at the LP sampling sites was 83 +/- 2% during baseline, and 80 +/- 2% in 26 paired samples during furosemide (p > 0.63). In 31 paired ED-LP collections, PR was 82 +/- 4 (ED) versus 72 +/- 4% (LP) during baseline, and 87 +/- 3 versus 74 +/- 6%, respectively, during furosemide. The respective collection rates were 4.6 +/- 1.0 versus 9.5 +/- 1.3 nl/min during baseline (p < 0.0001), 5.8 +/- 2.3 versus 8.7 +/- 3.0 nl/min during furosemide. The LP-ED differences obtained during baseline were not different from those measured during furosemide for the collection rate, PR and NFRs. The absolute LP resorption rate was not significantly different during baseline as compared to furosemide. Thus, furosemide did not affect the difference between ED and LP collection sites in collection rate, absolute and fractional reabsorption, in the absence of changes in GFR and NFR. These data indicate that furosemide acts solely along Henle's loop, where it blocks Na+ transport. The urine flow rate rises during furosemide because water abstraction along the distal tubule is reduced by the isotonicity of ED TF, and along the collecting ducts by the isotonicity of the medullary and papillary interstitium caused by the diuretic. We conclude that under the conditions of the present study, furosemide has no proximal effect.

Animals↗

PubMed2000

Input rate as a major determinant of furosemide pharmacodynamics: influence of fluid replacement and hypoalbuminemia.

To investigate how the response to a bolus and an infusion of furosemide is modulated by the rate of fluid replacement and by hypoalbuminemia, rabbits received 5 mg/kg of furosemide as a bolus or infused over 60 min, whereas diuresis was replaced with 13, 121, or 238 ml/h NaCl 0.9%/glucose 5% (50:50). Natriuretic and diuretic efficiencies were greater with the infusion than with the bolus of furosemide. Fluid replacement increased natriuretic and diuretic efficiency of furosemide bolus but only diuretic efficiency of furosemide infusion. Furosemide net fluid depletion reached a plateau when fluid replacement increased beyond 121 ml/h. Repeated plasmapheresis decreased plasma albumin by 30% (P <.05) and increased furosemide unbound fraction (P <.05). Compared with control rabbits, hypoalbuminemia decreased the natriuresis of the bolus (22.7 +/- 1.5-16.6 +/- 1.3 mmol, P <.05) but not that elicited by furosemide infusion (26.2 +/- 1.8 mmol). Given as a bolus, furosemide natriuretic and diuretic response as a function of its urinary rate of excretion exhibited an hyperbolic relationship, and after its infusion a clockwise hysteresis, denoting tolerance. Plasma renin activity was increased by the bolus and the infusion of furosemide, even in the presence of 121 ml/h of fluid replacement. It is concluded that: 1) the increase in natriuretic/diuretic efficiency of the bolus induced by fluid replacement is greater than when furosemide is infused, 2) furosemide net effect does not increase proportionally to fluid replacement, and 3) the infusion of furosemide prevents the hypoalbuminemia-induced decrease in response of furosemide given as a bolus.

Animals↗

PubMed1985

Furosemide choleresis in isolated perfused rat liver: partial dependency on perfusate sodium and chloride.

The effect of furosemide on hepatic bile formation was studied in isolated perfused rat liver to determine if 1) the observed cholestatic effect at lower dose of furosemide in vivo is a primary effect or a secondary effect due to decreased hepatic blood flow caused by the furosemide-induced volume contraction and if 2) the observed choleretic effect at higher doses can be explained by the osmotic effect of furosemide and its metabolites in bile. A single dose of furosemide (initial perfusate concentration 0.01, 0.1 or 1 mM) produced choleresis, whereas 0.001 mM furosemide did not affect bile flow significantly. Because furosemide failed to produce cholestasis at tested doses, the observed cholestasis in vivo at similar blood concentrations must be a secondary effect. Furosemide choleresis was associated with biliary secretion of furosemide and its metabolites. However, the choleretic effect expressed as microliters per micromole of drug secreted declined with increasing dose and biliary secretion. Furosemide choleresis was also associated with an increase in the net biliary secretion of Na+ and Cl-. The effect of Na+ and Cl- replacement on furosemide choleresis was studied to determine if the choleresis was a result of direct effect of furosemide on hepatic electrolyte transport. Replacement of perfusate Na+ completely by Li+ or partially by choline+ resulted in a 30 to 50% reduction in choleretic effect and furosemide-induced biliary Cl- secretion. A similar decline in choleretic effect and net furosemide-induced biliary Na+ secretion was also observed when perfusate Cl- was replaced by nitrate, acetate or isethionate.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1980

Pharmacokinetic-dynamic analysis of the indomethacin-furosemide interaction in man.

Indomethacin decreased the natriuretic response to furosemide. A possible mechanism of this effect of indomethacin, independent of prostaglandin synthetase inhibition, is a pharmacokinetic drug interaction in which indomethacin affects access of furosemide to its intratubular site of action. We administered 40 and 20 mg of furosemide to eight normal volunteers with and without pretreatment to eight normal volunteers with and without pretreatment with indomethacin. Furosemide concentration in serum and urine samples was measured by high performance liquid chromatography. Indomethacin significantly decreased plasma clearance of furosemide from 1.84 +/- 0.36 to 1.10 +/- 0.08 ml/kg/min (P < 0.2) and renal clearance of furosemide from 1.05 +/- 0.23 to 0.60 +/- 0.06 ml/kg/min (P < 0.05). The nonrenal clearance of furosemide decreased, but not significantly, from 0.80 +/- 0.17 to 0.50 +/- 0.10 ml/kg/min. Neither the total amount of furosemide delivered into the urine, nor the time course of furosemide delivery after the 40 or 20 mg doses changed with indomethacin pretreatment. Indomethacin significantly altered dose-response curves of furosemide. While the serum concentration-response curves of furosemide significantly shifted to the right, the urinary furosemide-response curve did not shift after indomethacin pretreatment. However, with both analyses, maximal response decreased. Indomethacin altered furosemide disposition and delivery into the urine. Nevertheless, this pharmacokinetic drug interaction did not account for the inhibitory effect of indomethacin on the response of furosemide.

Adult↗

PubMed1998

Mechanism of ascorbic acid enhancement of the bioavailability and diuretic effect of furosemide.

The following possible explanations for the significant increases in the oral bioavailability and the diuretic and natriuretic effects of orally administered furosemide observed when ascorbic acid was coadministered to dogs were investigated: ascorbic acid might enhance the gastrointestinal (GI) absorption of furosemide, might inhibit GI wall metabolism of furosemide, might enhance the reabsorption of furosemide from the renal tubules, and might increase the unionized fraction of furosemide at the receptor sites. The significant increase in the oral bioavailability with coadministration of ascorbic acid seemed to result from reduced gastric first-pass metabolism of furosemide and not enhanced GI absorption of furosemide. This might be supported by rat studies; the percentages of the oral doses of furosemide recovered from the GI tract at 8 hr after oral administration were similar (p < 0.583) without (39.5%) and with (44.7%) coadministration of ascorbic acid, and the amounts of furosemide remaining per gram of stomach after 30-min incubations of 50 micrograms of furosemide with 9000g supernatant fractions of stomach homogenates were increased significantly (48.5 vs. 42.4 micrograms) by the addition of 100 micrograms of ascorbic acid. The significant increases in the diuretic and natriuretic effects of furosemide with ascorbic acid could be the result of increases in the reabsorption of furosemide from renal tubules and increases in the unionized fraction of furosemide at the renal tubular receptor sites. This was supported by 1.5-4.2-fold increases in urine output and approximately 20% decreases in the time-averaged renal clearance of furosemide when the urine pH was decreased by 1.5-2.5 units by oral administration of ammonium chloride.

Animals↗

PubMed1991

High doses of furosemide in children with acute renal failure. A preliminary retrospective study.

The diuretic effect of high doses of furosemide alone and furosemide plus mannitol was analysed retrospectively in 30 children with acute renal failure. In 10 children (Group 1) renal failure developed mainly during glomerulonephritis, and in 20 children (Group 2) the cause was gastroenteritis. The diuretic effects of furosemide and furosemide plus mannitol were evaluated measuring the 24-hour urine volume at the time of anuria, oliguria or normal diuresis. The highest mean single intravenous doses of furosemide were 6.5 and 14 mg/kg in Groups 1 and 2, respectively; the highest average daily doses were 10.1 and 25.5 mg/kg, respectively. A broad relationship was observed between single i.v. dose and diuretic response following administration of furosemide (1.2 to 30.8 mg/kg). In both groups of patients a statistically significant negative linear correlation was found between the daily intravenous dose of furosemide and the 24-hour urine volume. Calculations based on the obtained regression equations showed that the expected 24-hour urine volumes corresponding to daily diuresis normal for age could be obtained after administration of daily 2.8 to 1.4 mg/kg furosemide in Group 1 and 9.3 to 2.3 in Group 2. It is therefore suggested that the total daily dose of furosemide should not exceed 100 mg in children with acute renal failure. Administration of furosemide plus mannitol did not result in higher daily diuresis as compared to 24-hour urine volume obtained when furosemide was given alone. Furosemide was well tolerated. Electrolyte disturbances, especially in Group 2, were the most frequent side effects due to high doses of furosemide.

Acute Kidney Injury↗

PubMed1989

Binding of 14C-furosemide to isolated human erythrocytes.

The incubation of 14C-furosemide at high specific activity with intact red blood cells at 37 degrees C, pH 7.4, has enabled the furosemide binding sites to be characterized with respect to time course, affinity and specificity. The binding reaction was rapid, reversible and close to thermodynamic equilibrium. Binding was dependent on cell and furosemide concentration and was saturable. At equilibrium, pharmacological doses of furosemide competitively inhibited 14C-furosemide binding with 50% inhibition at 3 x 10(-5) M. The Na+/K+ pump inhibitor ouabain had no effect on the 14C-furosemide binding. Bumetanide, which is more potent than furosemide as inhibitor of Na+/K+ co-transport system and equally effective in inhibiting anion transport, was less effective than furosemide in displacing 14C-furosemide from its binding sites, suggesting a different mechanism of action for the two drugs in the red blood cell. The preincubation of erythrocytes with 4,4'-diisothiocyano-stilbene-2,2'-disulphonic acid (DIDS), the potent and specific inhibitor of anion permeability, reduced specific furosemide binding by more than 80% at a furosemide concentration of 0.1 microM, while it had little effect on the non-specific furosemide binding. Taken together, these data suggest that furosemide interacts with specific binding sites in the human red blood cell, whose nature has not been clarified, but whose location is probably on (or near) the protein in band 3, i.e. the membrane macromolecule-mediating anion transport.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗

PubMed1996

The influence of moderate hypoalbuminaemia on the renal metabolism and dynamics of furosemide in the rabbit.

1. The present study aimed to investigate the influence of hypoalbuminaemia on the pharmacokinetics and pharmacodynamics of furosemide. Hypoalbuminaemia was produced by repeated plasmapheresis, to attain plasma albumin concentrations of 21.6 +/- 0.9 g l-1, compared with 33.0 +/- 0.6 g l-1 in controls (P < 0.001). The per cent of bound furosemide in hypoalbuminaemic rabbits (90.8 +/- 0.7%) was lower than that in control rabbits (97.4 +/- 0.5%, P < 0.001). The kinetics of intravenous furosemide (2.5 mg kg-1) were studied in control (n = 6) and hypoalbuminaemic rabbits (n = 6). 2. To assess the effect of hypoalbuminaemia on extrarenal clearance of furosemide, functional anephria was induced by ligating the renal pedicles of 12 rabbits, which were segregated in two groups, with and without hypoalbuminaemia. 3. In the control group, total, urinary and metabolic clearances of furosemide were 11.8 +/- 1.0, 5.0 +/- 0.4 and 6.8 +/- 0.6 ml min-1 kg-1, respectively. Compared with control rabbits, in hypoalbuminaemic rabbits, total clearance of furosemide increased by 40% (P < 0.001), result of the enhancement of furosemide metabolic clearance (C1m) from 5 to 10 ml min-1 kg-1 (P < 0.01). In hypoalbuminaemic rabbits, urinary excretion of furosemide was reduced by 26% (2451 +/- 115 vs 1818 +/- 134 micrograms h-1, P < 0.01). In anephric rabbits, furosemide total clearance was 1.77 +/- 0.12 ml min-1 kg-1, value not affected by hypoalbuminaemia, confirming that the increase in C1m induced by hypoalbuminaemia occurs in the kidneys. 4. Compared with controls, in hypoalbuminaemic rabbits, the rate of urinary excretion (142 +/- 9 vs 74 +/- 8 ml h-1, P < 0.001) and the rate of excretion of sodium (18.6 +/- 0.9 vs 9.9 +/- 0.9 mmol h-1, P < 0.001) were very much reduced. However, the dose-response curves were not different. 5. In conclusion, hypoalbuminaemia is associated with an increase in renal metabolic clearance of furosemide, possibly because of the increase in furosemide unbound concentration, and a decrease in the diuretic/natriuretic effect of furosemide, secondary to a reduction in furosemide tubular secretion. Thus, albumin facilitates the renal secretion of organic anions but not their metabolism.

Animals↗

PubMed1980

Effects of fasting on the diuretic response and disposition of furosemide in rats.

The influence of fasting on the relationship between the disposition and diuretic effect of furosemide was studied in rats. Fasting consisted of withholding solid food, but not water, for a period of 16 h before administering furosemide (10 mg/kg, sc) or a saline vehicle. Normally fed animals also received furosemide or the vehicle. Fasting did not modify the diuretic or the natriuretic effect (per 100 g body weight) of furosemide. The distribution of total furosemide in plasma or tissues was not affected by fasting. On the other hand, fasting which produced increasing amounts of endogenous free fatty acids in plasma and kidneys increased the concentration of free furosemide in fasting plasma but not in fasting kidney or liver of rats. The in vitro binding constant of furosemide to physiological concentrations of plasma proteins was decreased from the control value by a factor of 6.5 as a result of fasting. Neither unchanged furosemide nor its metabolite in the urine was affected by fasting. Incubation of kidney cortex tissue slices with furosemide both in the presence and absence of free fatty acid indicated an inhibition of furosemide uptake in a manner closely parallel to inhibition by probenecid. Thus, failure to observe a more pronounced diuretic and saluretic effects of furosemide in fasted rats, in spite of higher concentration of free plasma furosemide, might be due to the inhibitory effect of endogenous free fatty acids and (or) other endogenous substances on the uptake of furosemide by renal tubular cells although some homeostatic control mechanisms related to fasting could also be involved.

Animals↗

PubMed1978

The influence of indomethacin on the pharmacokinetics, diuretic response and hemodynamics of furosemide in the dog.

Indomethacin has the potential to interact with furosemide in a number of different fashions. We have investigated some of these possibilities in seven mongrel dogs that received furosemide (2 mg/kg i.v.). Plasma and urinary concentration of furosemide were measured by high performance liquid chromatography, diuretic response was assessed by urinary sodium excretion and renal blood flow and its distribution were estimated using the radioactive microsphere technique. Furosemide induced a prompt diuresis associated with a 50% increase in total renal blood flow. Intrarenal blood flow was preferentially increased in the inner cortical zones. Furosemide was rapidly eliminated with a renal clearance that was 35% of the total systemic clearance. Maximal sodium excretion was attained at plasma furosemide concentrations greater than 0.8 microgram/ml; below this concentration there was a linear relationship between plasma concentration and rate of sodium excretion. The ratio of sodium/furosemide concentration in urine rose to a plateau, then remained constant. Indomethacin pretreatment inhibited the hemodynamic response to furosemide. In addition, indomethacin reduced the renal and extrarenal clearance of furosemide by approximately 30%, but did not change the proportion of unchanged drug excreted in the urine. Although the diuretic response for any given plasma concentration of furosemide was reduced, the ratio of urinary sodium/furosemide concentration was not changed by indomethacin. Since the amount of furosemide reaching the urine was not altered, the total diuretic response was not significantly affected by indomethacin. From these observations we conclude that indomethacin alters the pharmacokinetics of the disposition of furosemide and furosemide-induced renal hemodynamic changes. However, our data indicate that the response of the renal tubule to furosemide secreted into tubular fluid is not changed by indomethacin.

Animals↗

PubMed1982

Nonrenal clearance of furosemide as a cause of diuretic response variability in the rat.

In clinical practice, the patient-to-patient variability in furosemide response is a well known fact. To study whether changes in furosemide metabolism may contribute to this variability, 72 rats received furosemide in a dose of 5 mg/kg i.p. There was a good correlation between the percentage of furosemide recovered in the urine and the diuretic effect. Accordingly, the rats were separated into groups corresponding to good responders (GR) and poor responders (PR) based on the extent of diuresis and the percentage of furosemide recovered in the urine. In an in vivo experiment, 12 rats received 30 mg/kg of chloramphenicol i.p. 30 min before furosemide. In PR rats, the average percentage of furosemide (+/- S.D.) in urine increased from 24.1 +/- 6.3 to 67.1 +/- 8.9 (P less than .001) and urine volume increased from 13.5 +/- 4.6 to 28.6 +/- 3.5 ml/24 hr (P less than .005). No such changes were observed in the group of GR rats. In a subsequent experiment, 11 GR rats received 80 mg/Kg of phenobarbital i.p. for 5 days before furosemide. The percentage of furosemide recovered in the urine decreased significantly (53.4 +/- 10.2 to 39.8 +/- 7.2, P less than .01), although the diuretic effect was not modified. In vitro studies confirmed that the T 1/2 of furosemide biotransformation in liver was different in GR and PR rats: 63.6 +/- 5.5 vs. 43.5 +2- 2.8 min, respectively (P less than .001). After receiving chloramphenicol, PR rats showed a longer T 1/2 of biotransformation in liver of 54.8 +/- 6.4 min (p less than .05 when compared to PR controls). After the administration of phenobarbital, GR rats showed a short T 1/2 of 35.3 +/- 7.0 min (P less than .005 when compared to GR controls). It is concluded that in the rat, the variability in diuretic responses to furosemide is related to the capacity of the individual rat to metabolize furosemide and that furosemide metabolism may be inhibited by chloramphenicol and increased by phenobarbital.

Animals↗

PubMed1984

Role of the furosemide-sensitive Na+/K+ transport system in determining the steady-state Na+ and K+ content and volume of human erythrocytes in vitro and in vivo.

To study the physiological role of the bidirectionally operating, furosemide-sensitive Na+/K+ transport system of human erythrocytes, the effect of furosemide on red cell cation and hemoglobin content was determined in cells incubated for 24 hr with ouabain in 145 mM NaCl media containing 0 to 10 mM K+ or Rb+. In pure Na+ media, furosemide accelerated cell Na+ gain and retarded cellular K+ loss. External K+ (5 mM) had an effect similar to furosemide and markedly reduced the action of the drug on cellular cation content. External Rb+ accelerated the Na+ gain like K+, but did not affect the K+ retention induced by furosemide. The data are interpreted to indicate that the furosemide-sensitive Na+/K+ transport system of human erythrocytes mediates an equimolar extrusion of Na+ and K+ in Na+ media (Na+/K+ "cotransport"), a 1:1 K+/K+ (K+/Rb+) and Na+/Na+ "exchange" progressively appearing upon increasing external K+ (Rb+) concentrations to 5 mM. The effect of furosemide (or external K+/Rb+) on cation contents was associated with a prevention of the cell shrinkage seen in pure Na+ media, or with a cell swelling, indicating that the furosemide-sensitive Na+/K+ transport system is involved in the control of cell volume of human erythrocytes. The action of furosemide on cellular volume and cation content tended to disappear at 5 mM external K+ or Rb+. The in vivo red cell K+ content was negatively correlated to the rate of furosemide-sensitive K+ (Rb+) uptake, and a positive correlation was seen between mean cellular hemoglobin content and furosemide-sensitive transport activity. The transport system possibly functions as a K+ and water-extruding mechanism under physiological conditions in vivo. The red cell Na+ content showed no correlation to the activity of the furosemide-sensitive transport system.

Biological Transport↗

PubMed1981

Furosemide kinetics in patients with hepatic cirrhosis with ascites.

Furosemide, 20 mg, was given intravenously as a bolus to seven patients with cirrhotic ascites and a 10-mg intravenous bolus dose was given to three normal subjects. Furosemide concentrations were measured by a specific high-performance liquid chromatographic analytic method. The median plasma elimination half-life (t1/2), volume of distribution at a steady state (VdSS), and VDarea of furosemide were 0.70 hr, 91 ml/kg, and 119 ml/kg in normal subjects. In the cirrhotic patients elimination t1/2 and Vd at steady state doubled and the Vdarea of furosemide was almost double that of the normal. There were no differences in plasma clearance or renal and nonrenal clearance between patients and controls, but five of the seven patients had lower renal clearances than controls. The water and sodium response to furosemide was directly related to the urinary furosemide excretion rate. We identified a subset of cirrhotic patients who responded poorly (125 ml/hr urinary output in the first 4 hr after furosemide compared to 300 ml/hr in the other patients and 400 ml/hr in the controls) to furosemide. These "poor responders" had the lowest renal clearance of furosemide and the lowest urinary furosemide excretion rates. Our data indicate that furosemide kinetics are altered in patients with cirrhotic ascites and lack of response in a subset of these patients is due to lack of delivery of furosemide to the renal site of its action.

Adult↗

PubMed1980

Furosemide-induced vasodilation: importance of the state of hydration and filtration.

The circumstances under which furosemide increases renal blood flow was examined in mongrel dogs as it may relate to a tubuloglomerular feedback mechanism. Two maneuvers, desoxycorticosterone (DOCA) plus salt treatment and inhibition of tubular fluid flow, were used in the dogs to evaluate the renal vascular effects of furosemide because these maneuvers have been reported to blunt the tubuloglomerular feedback in micropuncture studies. In addition, we also used two structurally different nonsteroidal antiinflammatory drugs to assess the importance of prostaglandins to achieve furosemide's renal vasodilatation. Furosemide (5 mg/kg, i.v.) increased renal blood flow in volume-depleted animals from a baseline flow of 141 +/- 28 ml/min to a maximum of 176 +/- 35 ml/min at 6 min after furosemide administration. If the animals were pretreated with a high-salt diet and i.m. DOCA for 5 days, furosemide administration produced no renal vascular effects but still caused a large diuresis, and these dogs still had a responsive renal vascular bed to infused prostaglandin E2. In addition, kidneys rendered non-filtering in volume-depleted animals had no renal vascular response to furosemide. Volume-depleted animals, pretreated with either indomethacin or sodium meclofenamate, did not have a renal vascular response to furosemide although they did have a diuretic response and a responsive renal vasculature to prostaglandin E2. From our data, we hypothesize that the renal vascular response to furosemide is secondary to a tubular mechanism mediated by a vasodilatory prostaglandin. Because furosemide has been shown to disrupt the tubuloglomerular feedback mechanism, and the two maneuvers, DOCA plus salt treatment and lack of filtration, blunt the tubuloglomerular feedback response as well as inhibit the renal vascular response to furosemide, we further hypothesize that furosemide-induced renal vasodilation may be secondary to the disruption of an active tubuloglomerular feedback mechanism.

Animals↗

PubMed1991

Binding inhibitors restore furosemide potency in tubule fluid containing albumin.

We have previously suggested that albumin in tubule fluid at concentrations found in the nephrotic syndrome (NS) binds furosemide, thereby diminishing diuretic effect. This mechanism may contribute to diuretic resistance in NS. If this hypothesis is correct, displacement of albumin from furosemide should restore diuretic response in tubule fluid containing albumin. To test this supposition, in vivo loop microperfusion was performed in rats using perfusates containing 6 microM furosemide in the presence or absence of 3.8 microM albumin, or furosemide and albumin to which 12 microM warfarin or 5.4 mM sulfisoxazole had been added. These drugs are inhibitors of albumin-furosemide binding in plasma. Albumin in the perfusate impaired furosemide effect on loop chloride reabsorption (1248 +/- 59 vs. 886 +/- 65 pEq/min; P less than 0.05). Addition of warfarin or sulfisoxazole to perfusate containing albumin normalized furosemide's effect. Neither drug affected furosemide response in the absence of albumin. Dansylsarcosine, a probe that binds albumin at a different site than furosemide, failed to normalize furosemide response in albumin perfusates. These data suggest that albumin in tubule fluid reduces diuretic response through a diminution in the free furosemide concentration. In as much as this mechanism contributes to diuretic resistance observed clinically in NS, displacement of furosemide from albumin binding sites may be a therapeutic strategy warranting study.

Albumins↗

PubMed2006

Influence of mannitol and furosemide, alone and in combination, on brain water content after fluid percussion injury.

BACKGROUND: Furosemide and mannitol are used to reduce intracranial pressure, but the impact of furosemide on edema of injured brain is unclear. The authors examined the effects of furosemide and mannitol, alone and in combination, on brain water content in brain-injured rats. METHODS: Anesthetized rats were subjected to a 2.2-atm left hemispheric fluid percussion injury. Two and three-quarters hours later, animals received 0.5, 1, 4, or 8 g/kg mannitol; 8 mg/kg furosemide; a combination of 4 g/kg mannitol plus 4 mg/kg furosemide; or 8 g/kg mannitol plus 8 mg/kg furosemide. One hour later (4 h after injury), plasma osmolality was measured, and hemispheric water content was determined by drying. Other animals were subjected to injury without drug treatment (impact only) or did not undergo injury (control). Pairwise group comparisons regarding the effects of mannitol and furosemide were restricted to only four groups: impact only, 8 g/kg mannitol, 8 mg/kg furosemide, and 8 g/kg mannitol plus 8 mg/kg furosemide. RESULTS: The water content of both hemispheres in the impact-only group was greater than in the control group (left greater than right). Mannitol, 8 g/kg, increased osmolality from 306 +/- 4 to 351 +/- 6 mOsm/kg (mean +/- SD) and reduced water content in the left hemisphere from 80.06 +/- 0.84% (impact only) to 78.24 +/- 0.73%. Furosemide, 8 mg/kg, had no effect on osmolality or water content. Brain water in animals treated with 8 g/kg mannitol plus 8 mg/kg furosemide did not differ from that seen with 8 g/kg mannitol alone. CONCLUSIONS: Mannitol increased plasma osmolality and reduced water content of the injured and contralateral hemispheres, whereas the authors observed no effect of furosemide when given either alone or in combination with mannitol.

Animals↗