Combined application of low-dose dopamine and phentolamine for treatment of edema in children with nephrotic syndrome / 中国小儿急救医学

Objective To explore the efficacy and safety of low dose dopamine combined with phentolamine in the treatment of primary nephrotic syndrome (PNS) with edema. Methods Retrospective control studies were performed in 155 patients of PNS with edema, who received comprehensive treatment with small dose dopamine combined with phentolamine (group A). Patients treated with furosemide infusion were recruited as control (group B). Results The urinary output, urinary sodium increased after therapy in group A, showing significant differences (P ＜ 0. 01). But urinary potassium excretion, serum sodium and potassium showed no significant difference after therapy in group A. The urinary output, urinary sodium and potassium excretion increased and the serum sodium and potassium decreased after therapy in group B, all showing significant differences between before and after treatment (P ＜0. 01). The edema relief rate,urinary output, urinary sodium excretion, serum sodium and potassium in group A was significantly higher whereas urinary potassium excretion were significantly lower than those of group B(P ＜0. 01). The rate of drug adverse reaction in group A was significantly lower than that of group B. Conclusion Low dose dopamine combined with phentolamine in PNS with edema is safe and effective,which may be a substitute of diuretic like furosemide in the treatment of edema of patients with different blood volume.

Effects on Renal Functions of Low Dose Dopamine in Partial Hepatectomy Patients / 대한마취과학회지

BACKGROUND: Low dose dopamine is widely used during the perioperative period to preserve renal perfusion. Low dose dopamine (3-5 microgram/kg/min) was administrated to partial hepatectomy patients and BUN, creatinine in serum were measured to determine the effects of low dose dopamine on renal function. METHODS: Liver group (n = 28) were administered low dose dopamine (3-5 microgram/kg/min) and the stomach group (n = 23) were not administered any vasoactive drugs during the operation. Perioperative plasma BUN, and creatinine, creatinine clearance, BUN/creatinine ratio, serum Na+ and K+, and central venous pressure (CVP) were checked 3 times, just after starting operation, 4 hours after starting the operation, and at PACU for both groups. We also evaluated intravascular volume status using the CVP and the BUN/creatinine ratio. Changes in BUN, and creatinine level during the operation in both group were compared. All the patients in this study were confirmed as having euvolemia by CVP and BUN/creatinine ratio. RESULTS: Urine volume increased significantly in the liver group with low dose dopamine compared to the stomach group (P < 0.05). The BUN level in the liver group increased significantly versus the stomach group (P < 0.05). In both groups, the creatinine level increased significantly (P < 0.05) and the plasma Na+ level decreased significantly (P < 0.05). CONCLUSIONS: We confirmed that low dose dopamine significantly increases urine volume in euvolemia status cases during liver surgery. But we were unable to determine why increased diuresis by the administration of low dose dopamine during operation and has a renal protective effect.

The Effect of Low-dose Dopamine on Splanchnic and Renal Blood Flow in Patients with Septic Shock under the Treatment of Norepinephrine / 대한구급학회지

BACKGROUND: Norepinephrine, which is frequently administered as a vasopressor to the patients with septic shock, can decrease splanchnic and renal blood flows and aggravate splanchnic and renal ischemia. The low-dose dopamine (LDD) has been frequently combined with norepinephrine to ameliorate renal and splanchnic hypoperfusion in patients with septic shock. However, the effect of the LDD on the splanchnic and renal blood flow has not been fully elucidated. This investigation was carried out to determine the effect of the LDD on the splanchnic and renal blood flow in the patients with septic shock under the treatment of norepinephrine. METHODS: Eleven patients with septic shock were included in this study. All of them were under the norepinephrine treatment as the mean arterial pressure (MAP) was less than 70 mm Hg in spite of the adequate fluid resuscitation. With stabilization of MAP, the LDD (2 g/kg/min) was administered for two hours in each patients. Hemodynamics, gastric intramucosal pH (pHi), gastric regional PCO2 (rPCO2), rPCO2 - PaCO2, urine volume, urine sodium excretion and creatinine clearance were compared between with and without the LDD infusion. Diuretics was not used during the study period. RESULTS: Age of patients (n=11) was 64 12 and the APACHE III score was 84 17. The mortality rate of the subjects was 64%. Dosage of norepinephrine was 0.55 0.63 g/kg/min during the study period. There were no significant differences in hemodynamics (central venous pressure, cardiac output, pulmonary artery occlusion pressure, mixed venous gas), pHi, rPCO2, rPCO2 - PaCO2 depending on the concomitant infusion of the LDD. The volume of urine tended to increase (P=0.074) after concomitant LDD, but the changes in urine sodium excretion and creatinine clearance were not significantly different. CONCLUSIONS: The combined infusion of the LDD with norepinephrine did not improve splanchnic and renal blood flow in the patients with septic shock.

The Effect of Low-Dose Dopamine on the Renal Function of Asphyxiated Neonates

PURPOSE: Low-dose dopamine (0.5-3 microgram/kg/min) increases renal blood flow, glomerular filtration rate and natriuresis and has protective and therapeutic effects on oliguric renal failures. Asphyxia is the most common cause of acute renal failure in neonates. But the protective effects of dopamine have never been reported in asphyxiated neonates. So we reported the effects of low-dose dopamine on the renal function of asphyxiated neonates. METHODS: Twenty-seven asphyxiated neonates who were admitted to the neonatal intensive care unit of Ewha Womans University hospital, from September, 1995 to June, 1997, were randomized to dopamine group (N=14, dopamine 0.5-3 microgram/kg/min) and control group (N=13). Serum creatinine (Pcr) and Na (PNa), urine creatinine (Ucr) and Na (UNa), urine output, creatinine clearance rate (Ccr), fractional excretion of Na (FENa) of two groups were compared on postnatal day 1, 3, 5. Incidences of acute renal failure and neonatal complications were also checked. RESULTS: The postnatal changes of Pcr (mg/dL), Ccr (mL/min/1.73m2) and FENa (%), on lst, 3rd & 5th days were not significnatly diffrent between dopamine group and control group. The postnatal changes of UNa (mmol/day) and urine output (ml/kg/hr) in dopamine group on 1st, 3rd & 5th days were significantly higher than those of control group (P<0.05). The incidence of acute renal failure, intraventricular hemorrhage, bronchopulmonary dysplasia, patient ductus arteriosus, sepsis and necrotizing enterocolitis were not significantly different between two groups. CONCLUSION: Low-dose dopamine, which was prophylactically given after birth in asphyxiated neonates, showed natriuretic and diuretic effects without significant increase of glomerular function.