Furosemide and acute kidney injury: is Batman the cause of evil?

Abstract

As a drug directly acting on the tubules, furosemide has long been debated as a beneficial or detrimental drug for renal function, and the doubts have found no clear answer so far. Recent retrospective literature has highlighted the risk of acute kidney injury (AKI) worsening after diuretic administration. However, the significance of fluid balance in terms of organ dysfunction and, in particular, a fluid overload (the percentage of excess weight gained with respect to admission weight) cutoff of 10% or greater has been associated with worsened outcomes in both critically ill children and adults. Diuretics in critically ill children are not administered “to manage” AKI but to convert oliguric to non-oliguric (subclinical and established) AKI and are very effective because they improve the urine output component of AKI. However, they may tend to transiently increase the creatinine component of AKI due to pharmacodynamics of loop diuretics. In conclusion, congestive AKI can be effectively treated by loop diuretics and decongestion of organs dysfunctional for fluid accumulation may contribute to improving children’s survival, making it similar to that of non-congested ones.