Document Type: Research article
Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Neurosurgery, Emam Khomeini Hospital, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Community Medicine, Medical School, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Clinical Pharmacy , Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Sari, Iran
Department of Neurosurgery, Emam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
Immunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
Acute kidney injury (AKI) occurs both after traumatic brain injury (TBI) and after hypertonic saline administration; furosemide may be useful in preventing AKI indirectly. Serum neutrophil gelatinase-associated lipocalin (sNGAL) is superior to serum creatinine (sCr) in diagnosing early AKI. We compared the administration of hypertonic saline plus furosemide (HTS+F) versus hypertonic saline (HTS), using sCr and sNGAL to investigate kidney injury in patients with TBI.
This randomized, single-blind clinical trial was conducted from August 2016 to July 2017 in a neurosurgical intensive care unit, and included patients with a Glasgow Coma Score (GCS) 7-13 and brain edema. One group (n= 22) received hypertonic saline 5% (100 mL over 60 min then 20 mL/h) plusfurosemide (40 mg over 60 min then 0.05 mg/kgper hour) for 72 h. The other group (n = 21) received only hypertonic saline 5%, in the samedose as noted above. The sCr and sNGAL concentrations, GCS, and length of stay were measured.
Mean ± SD differences were -51.15 (47.07) and 9.96 (64.23) ng/mL for sNGAL and -0.12 (0.22) and -0.005 (0.2) mg/dL for sCr in HTS+F group and HTS group respectively (both p < 0.001). The incidence of stage one AKI according to Improving Global Outcomes (KDIGO) criteria was 4.5% in the HTS+F group and 19.0% in the HTS group (p = 0.16). Hypokalemia was common in both groups.
HTS+F group, compared with HTS group, was associated with lower concentrations of sCr and sNGAL. Incidence AKI (KDIGO criteria) did not have difference between groups.