Vasoactive drugs and acute kidney injury. Crit Care Med 36:S179-S186
ABSTRACT The use of norepinephrine, and probably vasopressor therapy in general, in intensive care patients with hypotensive vasodilatation despite fluid resuscitation and evidence of acute kidney injury remains the subject of much debate and controversy. Although there is concern about the use of these drugs, these concerns are unfounded. At this time, the experimental and human data strongly suggest that, in these patients, vasopressor therapy is safe and probably beneficial from a renal, and probably general, point of view. On the basis of currently available evidence, in hypotensive vasodilated patients with acute kidney injury, restoration of blood pressure within autoregulatory values should occur promptly with noradrenaline and be sustained until such vasodilatation dissipates. The additional role of other vasopressors in these situations remains unclear. The addition of vasopressin may be helpful in individual patients, but widespread use is not supported by evidence. Alpha-dose dopamine has no advantages over noradrenaline and is not as reliably effective in restoring blood pressure and urine output. Its widespread use cannot be supported in patients with vasodilatation and acute kidney injury. Other vasopressor drugs such as epinephrine and phenylephrine may be similar in efficacy to noradrenaline. However, experience and available data with their use is vastly less than with noradrenaline. Adrenaline, in addition, is associated with hyperglycemia, hyperlactatemia, acidosis, and hypokalemia. Terlipressin appears useful in patients with acute kidney injury secondary to hepatorenal syndrome. Whether it is superior to noradrenaline in this setting remains uncertain, and more studies are needed before recommendations can be made.
- SourceAvailable from: Enrico Fiaccadori
- "Nonostante il continuo e notevole rimpiazzo di fluidi o l'ottimizzazione del volume intravascolare nei pazienti con shock, l'Ipotensione persistente mette questi pazienti a rischio di sviluppare AKI. Nella gestione di una paralisi vasomotoria, la conservazione o il miglioramento della perfusione renale può essere raggiunto solo attraverso l'utilizzo di vasopressori sistemici, una volta ristabilito il volume intravascolare  . Non è chiaro se gli agenti vasopressori siano più efficaci nella prevenzione o nel trattamento dei pazienti con AKI e shock settico. "
Article: [In Process Citation].03/2015; 32(2).
- "Vasopressors, such norepinephrine, are employed to treat arterial hypotension during septic shock . Besides increasing renal blood flow through a restored renal perfusion pressure, norepinephrine increases glomerular filtration rate acting on the afferent-efferent arteriolar tone, with a more intense vasoconstrictive effect on efferent arteriola . "
Article: Cardiorenal Syndromes and Sepsis[Show abstract] [Hide abstract]
ABSTRACT: The cardiorenal syndrome is a clinical and pathophysiological entity defined as the concomitant presence of renal and cardiovascular dysfunction. In patients with severe sepsis and septic shock, acute cardiovascular, and renal derangements are common, that is, the septic cardiorenal syndrome. The aim of this paper is to describe the pathophysiology and clinical features of septic cardiorenal syndrome in light of the actual clinical and experimental evidence. In particular, the importance of systemic and intrarenal endothelial dysfunction, alterations of kidney perfusion, and myocardial function, organ "crosstalk" and ubiquitous inflammatory injury have been extensively reviewed in light of their role in cardiorenal syndrome etiology. Treatment includes early and targeted optimization of hemodynamics to reverse systemic hypotension and restore urinary output. In case of persistent renal impairment, renal replacement therapy may be used to remove cytokines and restore renal function.03/2011; 2011(4):652967. DOI:10.4061/2011/652967
Article: What's Old is New Again: AKI & ARF