noradrenaline and the kidney friends or foes去甲肾上腺素和肾的朋友或敌人.pdfVIP

Critical Care December 2001 Vol 5 No 6 Bellomo and Di Giantomasso Review Noradrenaline and the kidney: friends or foes? Rinaldo Bellomo and David Di Giantomasso Department of Intensive Care and Medicine, Austin and Repatriation Medical Centre, Melbourne, Australia Correspondence: Rinaldo Bellomo, rb@.au Published online: 22 October 2001 Critical Care 2001, 5:294-298 © 2001 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) Abstract Septic shock, systemic inflammation and pharmacological vasodilatation are often complicated by systemic hypotension, despite aggressive fluid resuscitation and an increased cardiac output. If the physician wishes to restore arterial pressure (80–85 mmHg), with the aim of sustaining organ perfusion pressure, the administration of systemic vasopressor agents, such as noradrenaline, becomes necessary. Because noradrenaline induces vasoconstriction in many vascular beds (visibly in the skin), however, it may decrease renal and visceral blood flow, impairing visceral organ function. This unproven fear has stopped clinicians from using noradrenaline more widely. In vasodilated states, unlike in normal circulatory conditions, however, noradrenaline may actually improve visceral organ blood flow. Animal studies show that the increased organ perfusion pressures achieved with noradrenaline improve the glomerular filtration rate and renal blood flow. There are no controlled human data to define the effects of noradrenaline on the kidney, but many patient series show a positive effect on glomerular filtration rate and urine outpu