A case of marked diuresis by combined dopamine and atrial natriuretic peptide administration without renal injury in acute decompensated heart failure.
Renal injury is an important factor for worsening outcome in acute decompensated heart failure (ADHF). An 81-year-old woman was admitted due to ADHF with dyspnea and mild peripheral edema. The patient was managed with intravenous administration of atrial natriuretic peptide (ANP) at a dose of 0.0125 μg/kg/minute, which did not control volume overload even at an increased dose of 0.025 μg/kg/minute. After a low dose of dopamine (DA) of 1.0 μg/kg/ minute was added, urine output increased markedly to 120 from 30 mL/hour. Furthermore, her heart rate decreased to 80-100 from 120 bpm and the congestion improved with a reduced brain natriuretic peptide level. Interestingly, the combination of ANP and DA therapy reduced serum creatinine as well as the levels of urinary liver-type fatty acid binding protein, a novel reno-tubular stress marker, by 98.9%, and an oxidative stress marker, urinary 8-hydroxydeoxyguanosine, by 88.2% from baseline levels. Thus, this ADHF patient, a nonresponder to ANP alone, improved without renal injury when administered combination therapy consisting of low doses of ANP and DA, suggesting that this combined therapy might be useful for better management of ADHF in patients without diuretic responses with ANP alone. Further prospective studies are warranted.
Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
Masataka
M
Kamiya
Naoki
N
Sato
Mai
M
Akiya
Hirotake
H
Okazaki
Yasuhiro
Y
Takahashi
Kyoichi
K
Mizuno
D000208:Acute Disease; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage* / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004231:Diuresis / Q000187:drug effects*; D004298:Dopamine / Q000008:administration & dosage* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D002316:Cardiotonic Agents; D009320:Atrial Natriuretic Factor; D004298:Dopamine