Letter: Renal failure in respiratory distress syndrome (RDS)

Acute oliguria in preterm infants with hyaline membrane disease: interaction of dopamine and furosemide

Ten premature infants with hyaline membrane disease and with acute oliguria were treated with furosemide or furosemide and dopamine. Furosemide alone did not increase diuresis. Furosemide when combined with dopamine, however, caused significant increases in urine output, sodium excretion, fractional sodium excretion and creatinine clearance. These data suggest that the increase in the sodium excretion was due not only to a reduction in the tubular sodium reabsorption but also to an increase in the glomerular filtration rate. Since in premature neonates the creatinine clearance is not a very precise index of the glomerular filtration rate, the extent of contribution of the increase in the glomerular filtration rate to the enhanced sodium excretion cannot be determined. Despite the increase in the sodium excretion, the serum sodium concentration did not fall significantly. We conclude that the combined treatment with dopamine and furosemide is useful for treating furosemide-resistant, severe functional renal failure in preterm infants with hyaline membrane disease.

Renal function in respiratory distress syndrome

Renal function wa assessed in 20 newborn infants with idiopathic respiratory distress syndrome and compared to that of 10 neonates without respiratory distress or renal disease. Inulin and PAH clearances were markedly depressed in neonates with RDS as compared to controls (5.9 +/- 0.6 vs 9.3 +/- 0.8 ml/min/m2 (p less than 0.01) and 13.5 +/- 2.0 vs 23.2 +/- 1.2 ml/min/m2 ( p less than 0.01), respectively). The impairment of inulin and PAH clearances correlated with the severity of the pulmonary disease. Improvement of the respiratory distress was followed by a progressive rise of inulin and PAH clearances toward normal values. Intravenous administration of hypertonic mannitol in three patients resulted in an immediate increase in urine flow and inulin and PAH clearances. It is concluded that a state of acute, reversible, renal insufficiency can occur in the acute phase of idiopathic respiratory distress syndrome.