Cotreatment with Furosemide and Hypertonic Saline Decreases Serum Neutrophil Gelatinase-associated Lipocalin (NGAL) and Serum Creatinine Concentrations in Traumatic Brain Injury: A Randomized, Single-Blind Clinical Trial

Document Type: Research article

Authors

1 Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.

2 Department of Neurosurgery, Emam Khomeini Hospital, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

3 Department of Community Medicine, Medical School, Mazandaran University of Medical Sciences, Sari, Iran.

4 Department of Clinical Pharmacy , Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Sari, Iran

5 Department of Neurosurgery, Emam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.

6 Immunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran

Abstract

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.

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