title: The changes in renal function after a single dose of intravenous furosemide in patients with compensated liver cirrhosis.
abstract: BACKGROUND
  Patients with compensated Child-A cirrhosis have sub clinical hypovolemia and diuretic treatment could result in renal impairment.
  
  
  OBJECTIVE
  To evaluate the changes in renal functional mass as reflected by DMSA uptake after single injection of intravenous furosemide in patients with compensated liver cirrhosis.
  
  
  METHODS
  Eighteen cirrhotic patients were divided in two groups; eight patients (group 1, age 56 +/- 9.6 yrs, Gender 5M/3F, 3 alcoholic and 5 non alcoholic) were given low intravenous 40 mg furosemide and ten other patients (group 2, age 54 +/- 9.9, Gender 6M/4F, 4 alcoholic and 6 non alcoholic) were given high 120 mg furosemide respectively. Renoscintigraphy with 100MBq Of Tc 99 DMSA was given intravenously before and 90 minutes after furosemide administration and SPECT imaging was determined 3 hours later. All patients were kept under low sodium diet (80mEq/d) and all diuretics were withdrawn for 3 days. 8-hours UNa exertion, Calculated and measured Creatinine clearance (CCT) were performed for all patients.
  
  
  RESULTS
  Intravenous furosemide increased the mean renal DMSA uptake in 55% of patients with compensated cirrhosis and these changes persist up to three hours after injection. This increase was at the same extent in either low or high doses of furosemide. (From 12.8% +/- 3.8 to 15.2% +/- 2.2, p < 0.001 in Gr I as compared to 10.6% +/- 4.6 to 13.5% +/- 3.6 in Gr 2, p < 0.001). In 8 patients (45%, 3 pts from Gr 1 and 5 pts from Gr 2) DMSA uptake remain unchanged. The mean 8 hrs UNa excretion after intravenous furosemide was above 80 meq/l and was higher in Gr 2 as compared to Gr 1 respectively (136 +/- 37 meq/l) VS 100 +/- 36.6 meq/l, P = 0.05). Finally, basal global renal DMSA uptake was decreased in 80% of patients; 22.5 +/- 7.5% (NL > 40%), as compared to normal calculated creatinine clearance (CCT 101 +/- 26), and measured CCT of 87 +/- 30 cc/min (P < 0.001).
  
  
  CONCLUSIONS
  A single furosemide injection increases renal functional mass as reflected by DMSA in 55% of patients with compensated cirrhosis and identify 45% of patients with reduced uptake and who could develop renal impairment under diuretics. Whether or not albumin infusion exerts beneficial effect in those patients with reduced DMSA uptake remains to be determined.
authors.affiliation: Liver Unit, Sieff Hospital, Safed, Israel. assy.n@ziv.health.gov.il
authors.forename: Nimer
authors.initials: N
authors.lastname: Assy
authors.forename: Mohib
authors.initials: M
authors.lastname: Kayal
authors.forename: Yoram
authors.initials: Y
authors.lastname: Mejirisky
authors.forename: Miguel
authors.initials: M
authors.lastname: Gorenberg
authors.forename: Osamah
authors.initials: O
authors.lastname: Hussein
authors.forename: Sorina
authors.initials: S
authors.lastname: Schlesinger
mesh_terms: D000368:Aged; D001692:Biological Transport / Q000187:drug effects; D003404:Creatinine / Q000378:metabolism; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D020896:Hypovolemia / Q000150:complications / Q000209:etiology; D007275:Injections, Intravenous; D007668:Kidney / Q000187:drug effects / Q000502:physiology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D004113:Succimer / Q000493:pharmacokinetics
chemical_list: D004232:Diuretics; D005665:Furosemide; D003404:Creatinine; D004113:Succimer