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Review
. 2021 Dec;43(1):830-839.
doi: 10.1080/0886022X.2021.1906701.

The furosemide stress test: current use and future potential

Blaithin A McMahon  1 , Lakhmir S Chawla  2
Affiliations
Review

The furosemide stress test: current use and future potential

Blaithin A McMahon et al. Ren Fail. 2021 Dec.

Abstract

Loop diuretics are among the most widely used drugs worldwide and are commonly employed in the management of complications associated with acute kidney injury (AKI), namely volume overload and electrolyte management. The use of loop diuretics in critically ill patients with AKI is paramount to preventing or treating pulmonary edema. The naturetic response to a loop diuretic is based on its unique renal pharmacology. Our review article summarizes the pharmacology of furosemide in the intact nephron and discusses how this response might be altered by the presence of AKI. We discuss the increasing body of literature on the latest clinical utility of furosemide namely, it's challenge test, known as the furosemide stress test which has highlighted a new and novel role for furosemide over the past number of years. This test assists with the identification of AKI subjects at higher risk of AKI progression and the need for renal replacement therapy. The stress test can also predict cessation of continuous renal replacement therapy in patients with established AKI. On the basis of the evidence presented in this review, we propose future potential studies of furosemide in AKI.

Keywords: Furosemide; acute kidney injury; renal replacement therapy; risk assessment; stress test.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Schematic diagram showing the 12 transmembrane domain Na-K-2Cl (NKCC) transporter in the thick ascending limb of the loop of Henle. Loop diuretics bind to the chloride-binding site (portions of the transmembrane domains 11 and 12) resulting in obstruction and subsequent inhibition of the NKCC-2 transporter domains 2, 4, and 7 transport Na, K, and/or Cl.
Figure 2.
Figure 2.
Testing of renal tubular integrity with the furosemide stress test in early AKI. In order for a brisk urinary response to furosemide there are four components that must be achieved. 1. Furosemide enters the blood stream and then must bind to albumin. 2. Active secretion by proximal tubular from the basolateral membrane to the lumen by the hOAT system. 3.Transport of the furosemide in the lumen dissolved in the glomerular filtrate transported to the TAL and binding to the Na- K-2Cl apical transporter. 4. Resultant diuresis.
See this image and copyright information in PMC

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