الفهرس 
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Abstract
The kidneys contain an intrinsic dopamine system that appears to be not related to neural dopamine systems. Dopamine is secreted locally in PCT cells from L-DOPA after glomerular filtration (1). Then it leaves the cell via its apical surface to induce paracrine actions through G-protein-coupled receptors, transmitted mainly through Gs to adenyl cyclase (2). Actions in renal system are not limited only to regulate natriuresis. Dopamine also improve the GFR by efferent arteriolar vasoconstriction. Dopamine modulates renin & ATII release, as well as controlling Na excretion and blood pressure. (3)
Due to dopamine actions and interactions with various systems (mainly adrenergic), dopamine plays a pivotal role in blood pressure regulation in hemodynamically unstable patients.(27) Stimulation of dopamine leads to natriuresis, diuresis, and improvement of RBF via vasodilation. For this reason, dopamine at low levels induce diuresis and at higher levels increases blood pressure.(28)
Acute renal failure is relatively common among Critically ill patients. Despite the advances in hemodialysis as biocompatible membranes has contributed towards improving the mortality rate of acute renal failure patients, AKI is still associated with high mortality and morbidity, especially in the setting multiple organ dysfunction.(29)
The current study was carried on 80 adult patients of both sexes. UV clearance, UOP & FENa was calculated before and after 24 hr of either LDD or furosemide administration to critically ill patients suffering from AKI. All patients were admitted to Critical Care Units in Alexandria main university.
The patients were randomized from 1 to 80 and classified into two groups according to type of the drug administered:
• group I: (Dopamine) (n: 40)
• group II: (Furosemide) (n: 40)
We have shown that the infusion of 2 mg/kg/min of dopamine for 24 hours increased the diuresis significantly but still Furosemide achieved slightly better UOP. Also ,our study showed that LDD has a notable impact on Crcl ,even better then furosemide especially in sepsis patients, where it was demonstrated that UV clearance before administration of dopamine ranged from 40.0 – 94.0 with a mean of 78.15 ± 16.79 ml/min while after administration of dopamine ranged from 50.0 – 117.0 with a mean of 87.80 ± 19.16 ml/min and Percent change of UV clearance in dopamine group ranged from -12.82 – 100.0 in sepsis group with median of 22.22, while ranged from -8.33 – 25.81 in other causes of AKI with median of -3.80 . This is in agreement with multiple researches on humans.
We did not detect any cardiac effects from LDD. However, although the safety of LDD in these situations has not been extensively assessed, it is known that dopamine may lead to serious cardiac complications in critically ill patients. Since that study showed that the use of dopamine seems to have a significant impact on FEN Na where FENa before administration of dopamine ranged from 0.80 – 3.0 with a median of 2.0 (1.0 – 2.25) % while after administration of dopamine ranged from 0.80 – 3.0 with a median of 1.45 (1.20 – 2.0) %. Its utilization with such indication is thought to be effective in critically ill patients. especially, in hypervolemic patients, dopamine use should be considered.
We propose that LDD shouldn’t be utilized for selective vasodilatory and natriuretic actions in AKI patients until their effectiveness is established in randomized controlled trials. However, the utilization of dopamine due to its systemic effects in congestive heart failure and sepsis patients should not be neglected, since this might have favorable effects