Furosemide acute renal failure

There is a risk of acute renal failure when iodi-nated contrast material that is used for radiological studies is administered with metformin. Metformin therapy is stopped for 48 hours before and after radiological studies using iodinated material. Alcohol, amiloride, digoxin, morphine, procainamide, quini-dine, quinine ranitidine, triamterene, trimethoprim, vancomycin, cimetidine, and furosemide all increase the risk of hypoglycemia. There is an increased risk of lactic acidosis when metformin is administered with the glucocorticoids. 

Acute drug-related hypersensitivity reactions (allergic responses) may cause tubulointerstitial nephritis, which will damage the tubules and interstitium. These reactions are most commonly observed with administration of methicillin and other synthetic antibiotics as well as furosemide and the thiazide diuretics. The onset of symptoms occurs in about 15 days. Symptoms include fever, eosinophilia, hematuria (blood in the urine), and proteinuria (proteins in the urine). Signs and symptoms of acute renal failure develop in about 50% of the cases. Discontinued use of the drug usually results in complete recovery however, some patients, especially the elderly, may experience permanent renal damage. 

Giving intravenous phosphate is probably the fastest and surest way to reduce serum calcium, but it is a hazardous procedure if not done properly. Intravenous phosphate should be used only after other methods of treatment (pamidronate, calcitonin, saline diuresis with furosemide, and plicamycin) have failed to control symptomatic hypercalcemia. Phosphate must be given slowly (50 mmol or 1.5 g elemental phosphorus over 6-8 hours) and the patient switched to oral phosphate (1-2 g/d elemental phosphorus, as one of the salts indicated below) as soon as symptoms of hypercalcemia have cleared. The risks of intravenous phosphate therapy include sudden hypocalcemia, ectopic calcification, acute renal failure, and hypotension. Oral phosphate can also lead to ectopic calcification and renal failure if serum calcium and phosphate levels are not carefully monitored, but the risk is less and the time of onset much longer. Phosphate is available in oral and intravenous forms as the sodium or potassium salt. Amounts required to provide 1 g of elemental phosphorus are as follows ... 

When renal function is compromised, treatment involves the use of drugs to increase RBF, glomerular filtration rate (GFR) and urine output. In equine patients with acute renal failure (ARF), furosemide (frusemide), dopamine and mannitol (Table 10.1) are the most common drugs utilized Qose-Cunilleras Hinchcliff 1999). 

Mason J, Kain H, Welsch J, Schnermann J The early phase of experimental acute renal failure. VI. The influence of furosemide. 

The risk of ACE inhibitor-induced renal impairment in patients with or without renovascular disease can be potentiated by diuretics. " In an analysis of 74 patients who had been treated with captopril or lisinopril, reversible acute renal failure was more coimnon in those who were also treated with a diuretic (furosemide and/or hydrochlorothiazide) than those who were not (11 of 33 patients compared with 1 of 41 patients). Similarly, in a prescription-event monitoring study, enalapril was associated with raised creatinine or urea in 75 patients and it was thought to have contributed to the deterioration in renal function and subsequent deaths in 10 of these patients. However, 9 of these 10 were also receiving loop or thiazide diuretics, sometimes in high doses. Retrospective analysis of a controlled study in patients with hypertensive nephrosclerosis identified 8 of 34 patients who developed reversible renal impairment when treated with enalapril and various other antihypertensives including a diuretic (furosemide or hydrochlorothiazide). In contrast, 23 patients treated with placebo and various other antihypertensives did not develop renal impairment. Subsequently, enalapril was tolerated by 7 of the 8 patients without deterioration in renal function and 6 of these patients later received diuretics. One patient was again treated with enalapril with recurrence of renal impairment, but discontinuation of the diuretics (furosemide, hydrochlorothiazide, and triamterene) led to an improvement in renal function despite the continuation of enalapril. ... 

A study assessing the risk factors for nephrotoxicity with aminoglycosides (tobramycin and gentamicin) enrolled 1489 patients, 157 of whom developed clinical nephrotoxicity. Of these patients 118 had no immediately identifiable cause (such as acute renal failure) and further evaluation of other risk factors found that the concurrent use of furosemide significantly increased the risk of nephrotoxicity. A clinical study evaluating a possible interaction found that furosemide increased aminoglycoside-... 

Nine out of 36 patients who developed acute renal failure while taking cefaloridine had also been taking a diuretic furosemide was used in 7 cases. Other factors such as patient age and drug dosage may also have been involved. The authors of this report related their observations to previous animal studies, which showed that potent diuretics such as furosemide and etacrynic acid enhanced the incidence and extent of tubular necrosis. Several other reports describe nephrotoxicity in patients given both cefalori-... 

A study in 4 healthy subjects found that indometacin 150 mg daily given with triamterene 200 mg daily over a 3-day period reduced the creatinine clearance in 2 subjects by 62% and 72%, respectively. Renal function returned to normal after a month. Indometacin alone caused an average 10% fall in creatinine clearance, but triamterene alone caused no consistent change in renal function. No adverse reactions were seen in 18 other subjects treated in the same way with indometacin and furosemide, hydrochlorothiazide or spironolactone. Five patients are reported to have rapidly developed acute renal failure after receiving indometacin and triamterene, either concurrently or sequentially. " ... 

An isolated report attributed a case of acute renal failure and rhabdomyolysis to treatment with bezafibrate 400 mg daily and furosemide 25 mg on alternate days. ... 

DeTorrente, A., Miller, P.D., Cronin, R.F., Paulsen, P.E., Erickson, A.L. and Schrier, R.W. (1978). Effects of furosemide and acetylcholine in norepinephrine-induced acute renal failure. Am. ]. Physiol, 235, F131-36... 

Bailey, R.R., Natale, R., Turnbull, D.I. and Linton, A.L. (1973). Protective effect of furosemide in acute tubular necrosis and acute renal failure. Clin. Sci. Mol Med., 45, 1-17... 

Acute renal failure was reported in a 35-year-old woman with systemic lupus erythematosus taking four capsules daily of a cat s claw product (species unspecified) for an unspecified length of time. The woman was also taking other medications including prednisone, atenolol, metolazone, furosemide, and nifedipine. Biochemical parameters for renal function were reported to return to normal after cessation of the cat s claw product (Hilepo et al. 1997). 

A 57-year-old healthy man on treatment for pulmonary TB presented with haemolysis and severe acute renal failure. His kidney biopsy showed acute tubulointersitital nephritis with no evidence of granulomas. RMP was discontinued, and he was treated with fluid repletion, iv furosemide and dialysis therapy. Patient significantly improved and discharged subsequently. 

The development of an acute interstitial inflammatory reaction in the kidney related to the administration of certain classes of drugs and leading to renal failure has been recognized for almost a century [42]. Antibiotics, in particular the sulfonamides [43] and semisynthetic penicillins [44, 45], were recognized as etio-logically associated in many instances. A retrospective review of 1068 kidney biopsies from 1%8 to 1997 by Schwarz et al. yielded acute interstitial nephritis in 6.5% of cases. In the majority of instances (85%) acute interstitial nephritis was drug related. Diuretics were implicated in 7.8 % of these cases [46]. Lyons et al. noted that four patients with proliferative glomerulonephritis and nephrotic syndrome treated with sulfonamide-derivative diuretics (furosemide or thiazides) developed severe renal failure, which reversed when the diuretic was withdrawn and prednisone was adminis-... 

Acute, fatal, renal failure developed in 2 patients with cardiac failure within 4 weeks of being treated with enalapril and furosemide, and in 2 similar patients renal impairment developed over a longer period. Reversible renal failure developed in a patient with congestive heart failure when captopril and metolazone were given. ... 

Reducing ascites from liver failure furosemide 1-2 mg/kg orally or SQ twice daily. Correcting pulmonary edema furosemide 2-4 mg/kg IV or IM two to four times daily. Combating acute renal faiure furosemide 5-20 mg/kg IV as needed... 

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