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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



Jafari M1 ; Ala S1 ; Haddadi K2 ; Alipour A3 ; Mojtahedzadeh M4 ; Ehteshami S5 ; Abediankenari S6 ; Shafizad M2 ; Salehifar E1 ; Khalili F1
Authors
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Authors Affiliations
  1. 1. Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
  2. 2. Department of Neurosurgery, Emam Khomeini Hospital, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  3. 3. Department of Community Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
  4. 4. Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Neurosurgery, Emam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
  6. 6. Immunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran

Source: Iranian Journal of Pharmaceutical Research Published:2018

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) plus furosemide (40 mg over 60 min then 0.05 mg/kg per hour) for 72 h. The other group (n = 21) received only hypertonic saline 5%, in the same dose 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. © 2018, Iranian Journal of Pharmaceutical Research. All rights reserved.