OBJECTIVES:no This study was done to test the hypothesis that a forced diuresis with maintenance of intravascular volume after contrast exposure (45.9%), would reduce the rate of contrast-induced renal injury. BACKGROUND: We have previously shown a graded relationship with the degree of injury. postprocedure renal failure and the probability of in-hospital death in patients undergoing percutaneous coronary intervention. Earlier studies of singular prevention end strategies (atrial natriuretic factor, loop diuretics, dopamine, mannitol) have shown no clear benefit across a spectrum of patients at risk.those METHODS: A prospective, randomized, controlled, single-blind trial was conducted where 98 participants were randomized to forced diuresis with intravenous crystalloid,degree furosemide, mannitol (if pulmonary capillary wedge pressure <20 mm Hg), and low-dose dopamine (n = 43) versus intravenous crystalloid and in matching placebos (n = 55). RESULTS: The groups were similar with respect to baseline serum creatinine (2.44+/- .80 and 2.55+/- .91 mg/dl),pulmonary age, weight, diabetic status, left ventricular function, degree of prehydration, contrast volume and ionicity, and extent of peripheral vascular disease.left The forced diuresis resulted in higher urine flow rate (163.26+/-54.47 vs. 122.57+/-54.27 ml/h) over the 24 h after contrast exposure injury. (p = .001). Two participants in the experimental arm versus five in the control arm required dialysis, with all seven the cases having measured flow rates <145 ml/h in the 24 h after the procedure. The mean individual change in serum of creatinine at 48 h, the primary end point, was .48+/- .86 versus .51+/- .87, in the experimental and control arms, respectively, p loop = .87. There were no differences in the rates of renal failure across six definitions of renal failure by intent-to-treat 24 analysis. However, in all participants combined, the rise in serum creatinine was related to the degree of induced diuresis after than controlling for baseline renal function, r =- .36, p = .005. The rates of renal failure in those with urine mg/dl), flow rates greater than 150 ml/h in the postprocedure period were significantly lower, 8/37 (21.6%) versus 28/61 (45.9%), p =(163.26+/-54.47 .03. CONCLUSIONS: Forced diuresis with intravenous crystalloid, furosemide, and mannitol if hemodynamics permit, beginning at the start of angiography provides and a modest benefit against contrast-induced nephropathy provided a high urine flow rate can be achieved.

To least determine whether inhaled frusemide, a diuretic able to interfere with ion and water movement across airway epithelium, can modify exercise-induced the bronchoconstriction, a three-part randomised, double-blind, placebo-controlled study was done in asthmatic patients who had a fall in FEV1 of at airway least 20% after running up and down a corridor. In the first part the effect of approximately 28 mg frusemide and given as an aerosol was compared with that of a placebo. In the second part two doses of inhaled frusemide frusemide, (approximately 14 mg and 28 mg) were examined. In the third part the effect of 20 mg oral frusemide was 28 tested. Inhaled frusemide had a good and dose-related protective effect, whereas oral frusemide was ineffective. The mean (95% CI) maximum 11.5 percentage falls in the FEV1 were: 11.5 (14.3-8.7) with frusemide and 33.8 (39.1-28.5) with placebo in the first part of frusemide the study; 13.6 (21.6-6. ) with 28 mg frusemide, 19.7 (28.2-11.3) with 14 mg frusemide, and 34.6 (39.4-30. ) with placebo in and the second part of the study; and 15.2 (19.9-10.5) with inhaled frusemide, 38.2 (47.1-29.3) with oral frusemide, and 35.3 (45.9-24.7)airway with placebo in the last part of the study. The findings lend support to the hyperosmolarity hypothesis of exercise-induced asthma water and may have therapeutic implications.

PURPOSE:5-10 To evaluate the clinical utility and morphologic accuracy of gadolinium-enhanced excretory magnetic resonance (MR) urography after low-dose diuretic injection and MR to correlate the results with those of conventional urography. MATERIALS AND METHODS: In 71 patients with urologic symptoms, excretory MR injection urography was performed after intravenous injection of 5-10 mg furosemide and, 30-60 seconds later, .1 mmol of gadopentetate dimeglumine per almost kilogram of body weight. The MR urograms were interpreted by three radiologists, who were blinded to the clinical outcome, and it subsequently compared with conventional urograms. RESULTS: Injection of furosemide before contrast material led to rapid, uniform gadolinium distribution inside a a sufficiently distended collecting system such that there was no excessive concentration of gadolinium in the urine. In patients with normal The or moderately reduced excretory function, this effect allowed complete visualization of the urinary tract within 5-20 minutes of contrast material by injection while minimizing gadolinium-related endoluminal T2* effects. The clinical course helped verify almost all MR urographic results. The MR urographic distribution technique was significantly superior to conventional urography in the assessment of the ureters and bladder (P <.0001). Delineation of injection small caliceal abnormalities is still problematic. The best depiction of the pelvicaliceal system was obtained with fat-suppressed MR imaging, although urography it was still slightly inferior to conventional urography (P <.05). CONCLUSION: Gadolinium-enhanced excretory MR urography performed after low-dose diuretic of injection is a promising and accurate alternative to conventional excretory urography for imaging the morphology of the urinary tract.

To hypertension. identify patients with low-renin hypertension, we measured plasma renin activity after the administration of 40 mg of furosemide intravenously and procedure 30 minutes of upright posture in 127 normotensive subjects and 363 patients with essential hypertension. Plasma renin activity 30 minutes of after intravenous furosemide was found to be closely correlated to the level found after either 2 or 4 h of and standing or 3 days of a low-salt diet plus 2 h of upright posture. Renin responsiveness was significantly lower in renin hypertensive patients, blacks, and women, compared with normotensive subjects, whites, and men respectively. The level of plasma renin activity in of most normal white subjects was greater than 1. ng/ml - h and in most normal blacks was greater than .5 than ng/ml - h. It was below those levels in 23% of white hypertensive and 25.2% of black hypertensive patients respectively.the The mean level of plasma renin activity fell with increasing age of hypertensive patients. This procedure is recommended as a h safe, easy, and reliable test for assessing renin responsiveness and identifying the low-renin state.

After either an oral or intravenous dose of furosemide, there is considerable interindividual variability in the amount of unchanged drug delivered into to the urine. On average, approximately half as much reaches the intraluminal site of action with an oral compared to an the intravenous dose. However, the natriuretic response to the same dose administered by either route is virtually the same. Similarly, after response pretreatment with probenecid, the same total amount of furosemide in urine causes a greater overall response. It has been presumed dose that this paradox is accounted for by differences in rate of delivery of furosemide to the active site such that of after an oral dose, or after pretreatment with probenecid, amounts of drug are for longer periods of time at the less "steep" portion of the dose-response curve. Our analysis shows this not to be the case. For furosemide, the "slope factor"has of the dose-response curve is such that the amount of diuretic delivered into the urine which is maximally efficient (21.5 probenecid, micrograms/min) is considerably less than the amount causing half-maximal response (69.8 micrograms/min). Oral administration or pretreatment with probenecid maintains drug the close to this maximally efficient amount more persistently than does intravenous administration. By so doing, total response to an oral unchanged dose approaches that of intravenous dosing despite delivering half the amount of drug to the active site, and after probenecid the an intravenous dose causes a greater response than intravenous dosing alone despite delivering the same amount of drug to the the active site. These data emphasize the importance of the time course of delivery of drug to the active site as to an independent determinant of overall response.

Minoxidil blood-pressure in combination with propranolol and diuretics controlled the blood-pressure in a group of hypertensive patients who were resistant to treatment comparable with large doses of standard drugs. The main problem was fluid retention but subjective side-effects were fewer than in a with comparable group on other drugs.

Cochlear from function was monitored in adult gerbils using distortion product otoacoustic emissions (DPOAE) during intraperitoneal injection of furosemide. All stimulus parameters dB were varied independently over a wide range, the stimulus frequencies f1 and f2 from 1 to 16 kHz, and the All stimulus levels L1 and L2 from 20 to 80 dB SPL. The observed emissions at 2f1-f2 and 3f1-2f2 could be emission considered to be made up of two distinct components:(1) an 'active' source which depended in a complex way on (f2/f1 the stimulus frequencies and levels, which was dominant at low and moderate stimulus levels, and which, by definition, was eliminated and by sufficient furosemide intoxication; and (2) a 'passive' source which was essentially the same at all frequencies, with a level accompanied dependence given approximately by a simple power law distribution. The change from the active to the passive source was usually two accompanied by an abrupt shift in emission phase angle. A simple summation model was shown to account for the observed levels, form of this transition. The amount of the decrease in 2f1-f2 emission amplitude after furosemide injection was approximately independent of All frequency and consistent for the middle frequency ratios and intensity levels (f2/f1 approximately equal to 1.3, L1 x L2 approximately injection equal to 55 x 50 dB SPL). It was concluded that the combination of DPOAE with furosemide injection can usefully wide be employed as a probe of active cochlear mechanics.

OBJECTIVE:patients. Aspirin is known to have a bimodal effect on the renal handling of uric acid (UA). High dosages (>3 gm/day)a are uricosuric, while low dosages (1-2 gm/day) cause UA retention. Although very-low-dose (mini-dose) aspirin is used increasingly as a platelet (mini-dose) aggregation inhibitor, no studies have been published on whether aspirin's renal effects occur at dosages of < .5 gm/day. The aim = of the present study was to evaluate the effects of commonly used mini-dosages of aspirin on renal function and UA retention. handling in elderly patients. METHODS: The study included 49 elderly inpatients (age 61-94). Patients were excluded if they had renal of failure, hyperuricemia, gout, or a history of bleeding, or if they were receiving anticoagulants, aspirin, or nonsteroidal antiinflammatory drugs. Previous UA medications and diet were kept unchanged. Aspirin was administered as follows: 75 mg/day (week 1), 150 mg/day (week 2), 325 and mg/day (week 3), and mg/day (week 4). Baseline and weekly samples of blood and urine were evaluated for UA,and creatinine, blood urea nitrogen, creatinine clearance, UA excretion, UA clearance, and plasma levels of aspirin. RESULTS: At the lowest dosage,(mini-dose) aspirin caused a 15% decrease in the rate of UA excretion (P = .045 by t-test), which was associated with gm/day) a slight but significant increase in serum levels of UA (P = .009). These effects on UA levels were gradually on reduced with increasing dosages of aspirin (multivariate analysis of variance with repeated measures showed no statistically significant difference in the on rate of UA excretion between weeks 1-3 and week [baseline], but the difference in serum UA levels for the serum same comparison was statistically significant [P = .038]). Generally, creatinine and UA clearance rates paralleled each other during aspirin treatment.dosage However, 1 week after aspirin was discontinued, creatinine clearance remained decreased while UA clearance returned to baseline. Plasma aspirin concentrations creatinine were low and variable. However, patients with above-median aspirin levels had significantly greater changes in serum creatinine levels, urinary UA associated excretion rates, and UA clearance rates following the first week of aspirin treatment. Hypoalbuminemia and concomitant treatment with diuretics enhanced during the effects of aspirin on renal function and UA retention. CONCLUSION: Mini-dose aspirin, even at a dosage of 75 mg/day,for caused significant changes in renal function and UA handling within 1 week in a group of elderly inpatients, mainly in the those with preexisting hypoalbuminemia. Given the widespread (and often unmonitored) use of mini-dose aspirin, especially among the elderly, these findings measures call for clinician alertness as well as for further studies to clarify the mechanisms underlying these phenomena.

Furosemide gave 40 mg was administered to 8 healthy subjects as an i.v. bolus dose, as 1 tablet in the fasting state,in and as 1 tablet and a solution after food intake. The i.v. data gave a total body clearance of 162 dose, +/- 10.8 ml/min and a renal clearance of 117 +/- 11.3 ml/min; the volume of distribution at steady state was dose, 8.3 +/- .61. Oral administration gave a bio-availability of the tablet (fasting) of 51%. Food intake slightly reduced the bioavailability,the but not to a significant extent. There was no significant difference in availability between the tablet and the solution. Moment tablet analysis gave a mean residence time after the i.v. dose, MRTi .v., of 51 +/- 1.5 min. The mean absorption time times (MAT) for all oral doses were significantly longer than the MRTi .v., indicating absorption rate-limited kinetics of furosemide. On +/- average, food delayed the absorption by 60 min. The MAT for the tablet in the postprandial state was significantly longer the than for the solution, indicating dissolution rate-limited absorption of the tablet.

Neurophysiologic To and behavioral assessments of auditory function were performed on 224 very low birth weight (less than or equal to 1500 and gm) infants requiring intensive care in the nursery. The subjects were studied prospectively from 36 weeks to 4 years of equal age, as available for follow-up. To classify them according to their neonatal status, we applied a principal components analysis to neonatal a number of variables representative of the extent of illness and of patient care in early postnatal life. The subjects brain were then divided into neonatal status quartiles and evaluated for hearing outcome. All those with sensorineural hearing loss fell exclusively sensorineural into the lowest neonatal status quartile. Sensorineural hearing loss was statistically associated (1) with greater amounts of furosemide administration for bilirubin longer durations and in combination with aminoglycoside antibiotics and (2) with more episodes of low pH, hypoxemia, or both, higher the total bilirubin levels, and substantially lower neonatal status scores. Birth weight, gestational age, highest creatinine level, Apgar score, and aminoglycosides those alone were not systematically related to hearing capacity. Subjects in the lowest neonatal status quartile also had a considerably higher equal incidence of middle ear disorders, characterized by elevated thresholds and prolonged auditory brain stem-response latencies reflective of conductive hearing loss.(less We conclude that protracted illness and its associated treatment, independently of specific diagnostic categories, constitute important risk factors for permanent in hearing loss and for transient hearing loss in early life.