ABSTRACT
In conclusion, dopamine has the unique ability, compared with other catecholamines, to improve renal blood flow, glomerular filtration rate, sodium excretion, and creatinine clearance, independent of its cardiac effects. In addition, low-dose dopamine can decrease renal and systemic vascular resistance, suppress aldosterone secretion, and interact with atrial natriuretic factor. Because of these clinically significant properties, dopamine has been used successfully to improve and treat acute oliguric renal failure in a variety of clinical situations as just described. In addition, there were no adverse or toxic cardiac effects, such as tachyarrhythmias or hypertension, detected with low-dose dopamine in studies reviewed for this publication. By increasing renal and mesenteric vasodilation, dopamine has been shown to be beneficial in preserving renal function in cardiac surgery, vascular surgery, liver transplantation, contrast-induced nephropathy, hypertension, and pediatric patients. A therapeutic renal effect has been observed in patients with hepatorenal syndrome or severe ovarian hyperstimulation syndrome, in patients requiring vasopressors and IABP, and in selected cases of acute oliguric renal failure and shock. Furthermore, the combination of low-dose dopamine with furosemide or prostaglandin results in enhanced renal effects. Further investigation is necessary to evaluate the important and specific therapeutic role of low-dose dopamine through prospective, randomized, double-blind studies. Until those data are available, the plethora of clinical evidence supporting the ability of low-dose dopamine to augment renal function continues to grow. For those who are skeptical, we offer the following suggestion: "The obscure we see eventually, the obvious takes a little longer"--E.R. Murrow.
