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Renal response to furosemide in very low birth weight infants during chronic administration
M H Mirochnick1, J J Miceli, P A Kramer
1Department of Pediatrics, University of Connecticut, Farmington.
Insights
Premature infants with bronchopulmonary dysplasia show reduced kidney response to furosemide with chronic use and increasing age. This indicates a need to adjust diuretic therapy for these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Pharmacology
Background:
- Bronchopulmonary dysplasia (BPD) is a common respiratory complication in premature infants.
- Diuretics, such as furosemide, are frequently used in BPD management to reduce fluid overload.
- Understanding the renal response to furosemide in this population is crucial for optimizing treatment.
Purpose of the Study:
- To investigate the renal response to both initial and chronic doses of furosemide in premature infants with BPD.
- To determine how renal sensitivity to furosemide changes with sustained use and increasing postconceptional age.
Main Methods:
- Seven premature infants with BPD were studied.
- Urine collections were performed over 12-hour periods after initial furosemide doses and after 1 and 3 weeks of chronic therapy.
- Urinary output, furosemide excretion, sodium, and creatinine concentrations were measured.
Main Results:
- A linear dose-response relationship was observed between urinary furosemide excretion and diuretic/natriuretic effects.
- Higher furosemide excretion rates were needed for similar responses during chronic dosing compared to initial doses, indicating decreased renal responsiveness.
- Increased postconceptional age at therapy initiation was associated with reduced initial furosemide responsiveness.
Conclusions:
- Renal sensitivity to furosemide decreases with chronic administration in premature infants with BPD.
- Increasing postconceptional age also correlates with diminished initial renal responsiveness to furosemide.
- These findings suggest renal adaptation to chronic furosemide therapy, necessitating potential dose adjustments.
Abstract:
Renal response to furosemide following initial and chronic doses was investigated in premature infants with bronchopulmonary dysplasia. Seven infants (mean birth weight = 890 +/- 216 g, mean gestational age at birth = 27.7 +/- 2.6 weeks, mean postnatal age at the start of diuretic therapy = 2.7 +/- 0.9 weeks) were studied. Twelve-hour urine collections were performed after the initial dose, and following chronic doses after 1 week and 3 weeks of therapy. Volume of each urine sample was measured and concentrations of furosemide, sodium and creatinine determined. Linear dose-response relationships were found between the logarithm of the urinary furosemide excretion rate and diuretic/natriuretic response (urine output and urinary sodium excretion rate). The furosemide excretion rate required to achieve midrange diuretic and natriuretic responses was significantly greater during chronic dosing than following initial doses, indicating a decrease in renal responsiveness to drug with sustained use. Increasing postconceptional age was associated with a decrease in initial responsiveness to furosemide. These data demonstrate that in premature infants renal sensitivity to furosemide decreases with chronic use as well as with increasing postconceptional age at the start of therapy. The decrease in renal sensitivity to drug with chronic use is of much greater magnitude, and appears to represent renal compensation for drug-induced diuresis and natriuresis.