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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
PubMed

Insights

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.
Abstract

Keywords:
acute kidney injurychildrenfurosemide stress testrenal replacement therapy

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