Related Experiment Video
Updated: Jan 8, 2026
06:38
Early Detection of Drug-Induced Renal Hemodynamic Dysfunction Using Sonographic Technology in Rats
Published on: March 11, 2016
12.5K
Furosemide Stress Test Use in Children at Risk for Acute Kidney Injury
Imogen Clover-Brown1, Giovanni Ceschia2, Katja M Gist3
1Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Kidney International Reports
|December 22, 2025
Summary
The furosemide stress test (FST) can predict severe acute kidney injury (AKI) and need for renal replacement therapy (RRT) in high-risk pediatric intensive care unit (PICU) patients. Urine flow rate (UFR) from the FST is a valuable predictor, even in established AKI.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Physiology
Background:
- The furosemide stress test (FST) assesses urine flow rate (UFR) post-furosemide administration.
- FST is established for predicting severe acute kidney injury (AKI) and need for renal replacement therapy (RRT) in adults.
- Data on FST utility in pediatric intensive care unit (PICU) patients, especially those stratified as high-risk using the renal angina index (RAI) and urine neutrophil gelatinase-associated lipocalin (uNGAL), is limited.
Purpose of the Study:
- To evaluate the prognostic performance of the FST in predicting severe AKI and RRT receipt in high-risk PICU patients.
- To assess the predictive value of urine flow rate (UFR) derived from the FST for adverse renal outcomes.
- To determine if FST has prognostic utility independent of AKI stage in this population.
Main Methods:
- Combined data from two prospective observational studies of high-risk PICU patients (RAI+ and uNGAL+).
- Compared outcomes between patients who underwent FST within the first week and those who did not.
- Analyzed FST responders versus nonresponders, examining UFR's predictive performance for new or persistent severe AKI or RRT receipt within 2 days.
Main Results:
- Of 273 high-risk patients, 112 underwent FST; 60% were nonresponders.
- FST nonresponders had higher AKI stages and significantly higher incidence of new/persistent severe AKI (89% vs. 37%) and RRT receipt (43% vs. 8%) compared to responders.
- UFR demonstrated strong predictive performance for severe AKI (AUROC: 0.89) and RRT receipt (AUROC: 0.84), with optimal cutoffs identified.
Conclusions:
- The FST is inconsistently applied in high-risk pediatric populations but provides significant prognostic information.
- UFR from the FST effectively predicts new or persistent severe AKI and RRT receipt in PICU patients.
- The prognostic utility of FST for severe AKI and RRT is independent of the initial AKI stage.
Related Concept Videos
01:20Acute Kidney Injury V: Interprofessional Care
277
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
277
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
243
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
243
01:22Acute Kidney Injury I: Introduction
519
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
519
01:22Acute Kidney Injury VI: Nursing Management
362
Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
362
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
171
Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
171
01:24Serum Studies: Renal Function Tests
341
Renal function tests are crucial for assessing kidney health, monitoring disease progression, and evaluating the kidneys' efficiency in waste elimination, fluid balance, and electrolyte regulation. These tests offer critical insights into kidney function, even though routine measurements may appear normal until there is a significant decline in the glomerular filtration rate or GFR. Typically, signs of kidney impairment only become evident when the GFR falls to about 50% of its normal level.
341