Natriuretic peptides and acute renal failure.
The characterization of a complex cerebrocardio-renal axis responsible for fluid and electrolyte homeostasis, with the isolation and identification of natriuretic peptides, has provided a potential therapeutic window into a condition associated with high morbidity and mortality in the ICU--acute renal failure (ARF). The potent natriuretic, diuretic, and renovascular actions of this family of peptides directly challenge the pathologic aberration in intrarenal hemodynamic and tubular function characterized by this condition. Unfortunately, human studies have not shown atrial natriuretic peptide to be the panacea as animal studies originally suggested. However, studies were clouded by the impact of polypharmacy, multisystem pathology, the timing of intervention, and the lack of any clear dose-response relationship for these peptides. Nonetheless, hormonal manipulation of physiologic aberration remains a potential therapeutic reality with ongoing isolation and understanding of new peptides, such as urodilatin, which may yet impact upon the treatment and outcome of ARF in the near future.
Weinmann
M
M
Wayne State University School of Medicine, Detroit, MI, USA.
D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000503:physiopathology*; D000818:Animals; D009320:Atrial Natriuretic Factor / Q000737:chemistry / Q000502:physiology* / Q000627:therapeutic use*; D015982:Bias; D002986:Clinical Trials as Topic; D004232:Diuretics / Q000627:therapeutic use; D004353:Drug Evaluation, Preclinical; D006801:Humans; D010446:Peptide Fragments / Q000627:therapeutic use
D004232:Diuretics; D010446:Peptide Fragments; C056452:Ularitide; D009320:Atrial Natriuretic Factor