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Review
. 2025 Apr 10;14(8):2595.
doi: 10.3390/jcm14082595.

The Furosemide Stress Test: A Dynamic Tool for Predicting Acute Kidney Injury Progression in Critical Care Medicine

Luigi La Via  1 , Giuseppe Cuttone  2 , Nicola Sinatra  3 , Maurizio Giuseppe Abrignani  4 , Giulio Geraci  5 , Giovanni Ippati  6 , Francesca Maria Rubulotta  1   7   8
Affiliations
Review

The Furosemide Stress Test: A Dynamic Tool for Predicting Acute Kidney Injury Progression in Critical Care Medicine

Luigi La Via et al. J Clin Med. .

Abstract

Acute kidney injury (AKI) remains a significant challenge in critical care medicine, affecting up to 50% of intensive care unit patients with substantial mortality rates. While traditional approaches to AKI assessment rely on static measurements like serum creatinine and urine output, the furosemide stress test (FST) has emerged as a dynamic functional tool for evaluating renal tubular function and predicting AKI progression. This comprehensive review examines the historical development, physiological basis, technical aspects, and clinical applications of FST in various patient populations. Originally developed and validated in 2013, FST has demonstrated superior predictive capabilities for AKI progression and the need for renal replacement therapy compared to conventional biomarkers. The test's mechanism relies on assessing the kidney's response to a standardized furosemide challenge, providing insights into both the structural integrity and functional reserve of the renal tubular system. Standardized protocols have been established for different clinical scenarios, though implementation challenges remain, including timing considerations, patient selection, and resource requirements. FST has shown utility in critical care, post-cardiac surgery, sepsis-associated AKI, and heart failure settings. Recent developments include integration with artificial intelligence, personalized medicine approaches, and combination with novel biomarkers. While limitations exist, including contraindications and technical challenges, ongoing research continues to refine protocols and expand applications. This review highlights FST's role as a valuable prognostic tool in modern AKI management and discusses future directions, including automated monitoring systems, protocol standardization efforts, and potential applications in different patient populations.

Keywords: acute kidney injury; critical care; furosemide stress test; nephrology; prognostic tool; renal function.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Chemical structure of furosemide.
See this image and copyright information in PMC

References

    1. Hoste E.A., Bagshaw S.M., Bellomo R., Cely C.M., Colman R., Cruz D.N., Edipidis K., Forni L.G., Gomersall C.D., Govil D., et al. Epidemiology of acute kidney injury in critically ill patients: The multinational AKI-EPI study. Intensive Care Med. 2015;41:1411–1423. doi: 10.1007/s00134-015-3934-7. - DOI - PubMed
    1. Kellum J.A., Romagnani P., Ashuntantang G., Ronco C., Zarbock A., Anderset H.J. Acute kidney injury. Nat. Rev. Dis. Primers. 2021;7:52. doi: 10.1038/s41572-021-00284-z. - DOI - PubMed
    1. Prowle J.R., Bellomo R. Sepsis-associated acute kidney injury: Macrohemodynamic and microhemodynamic alterations in the renal circulation. Semin. Nephrol. 2015;35:64–74. doi: 10.1016/j.semnephrol.2015.01.007. - DOI - PubMed
    1. KDIGO Group KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int. Suppl. 2012;2:1–138.
    1. Ostermann M., Joannidis M. Acute kidney injury 2016: Diagnosis and diagnostic workup. Crit. Care. 2016;20:299. doi: 10.1186/s13054-016-1478-z. - DOI - PMC - PubMed

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