Stanley Goldfarb, MD
Potential Financial Conflicts of Interest:Consultancies: GE Healthcare, Fresenius. Honoraria: GE Healthcare, Fresenius, AstraZeneca, Omeros. Stock ownership or options (other than mutual funds): Polymedix.
Requests for Single Reprints: Stanley Goldfarb, MD, University of Pennsylvania School of Medicine, Stemmler Hall, Suite 100, 3450 Hamilton Walk, Philadelphia, PA 19104-4283; e-mail, firstname.lastname@example.org.
Adapted for publication in Annals of Internal Medicine by Jennifer Fisher Wilson and Michael Berkwits, MD, MSCE.
Goldfarb S.; Update in Nephrology. Ann Intern Med. 2008;148:49-54. doi: 10.7326/0003-4819-148-1-200801010-00007
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Published: Ann Intern Med. 2008;148(1):49-54.
The current Update in Nephrology reviews the most important recent articles relevant to those practicing nephrology. The Table summarizes changes to clinical practice that should emerge from these articles.
Question: Is furosemide safe and effective for treating acute renal failure?
Study Design: Meta-analysis of randomized, controlled trials.
Data Sources: Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE.
Outcomes: Primary outcomes were in-hospital death and the proportion of patients requiring renal dialysis or replacement therapy. Secondary outcomes were the proportion of patients remaining oliguric (urine output <500 mL/d), proportion of patients who developed ototoxicity, number of dialysis sessions required until recovery, and length of hospital stay.
Institute of Digestive Diseases, Xijing hospital, Fourth Military Medical University, Xi'an, China
January 13, 2008
Use of Furosemide in acute renal failure for patients with decompensate cirrhosis
To the editor:
As Stanley Goldfarb MD reported, Furosemide was not associated with clinical benefit in the prevention and treatment of acute renal failure in adults . Ho KM et al evaluated four kinds of outcomes and drew a conclusion that stopping Furosemide should be a valuable strategy for the prevention or treatment of acute renal failure . However, our clinical data showed that the strategy was doubtful and need upgrade.
Acute renal failure might be one complication of hepatitis B virus infection. From Jan 2007 to Nov 2007, 265 patients (188 men, 77 women, 34- 68 years) with hepatitis B virus-induced decompensate cirrhosis were investigated. Among them, 23 cases were identified as patients with or at risk for acute renal failure. They all suffered from oliguresis (<500 mL/d) and received Furosemide and Spironolactone therapy. The result showed that 74% of them (17/23) benefited from combined therapy of Furosemide and Spironolactone. The average urine output per day significantly increased from <500 mL to > 800 mL. The point was that the combined therapy might be helpful for improving fluid and electrolyte balance and improving the liver functions, thus leading to reversal of renal failure. As for another 242 patients, Furosemide therapy was also proved to be helpful for prevention of acute renal failure by decreasing the amount of ascites and inducing endocrine balance. Thus, Furosemide might be valuable for prevention or treatment of acute renal failure in patients with hepatitis B virus-induced decompensate cirrhosis.
The data sources of Ho KM et al didn't involve the patients with hepatitis B virus-induced decompensate cirrhosis . It might be the reason why their conclusions need upgrade.
1 Stanley G. Update in Nephrology. Ann Intern Med. 2008; 148(1): 49- 54.
2 Ho KM, Sheridan DJ. Meta-analysis of frusemide to prevent or treat acute renal failure. BMJ. 2006; 333(7565): 420.
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