Urine Output In Patients Research Articles

Prognostic value of first 24-hour urine output in patients with acute myocardial infarction in intensive care units: a retrospective study based on the MIMIC-IV database.

To investigate the effect of first 24-hour (24-h) urine output (UO) on in-hospital and 1-year mortality in patients admitted to intensive care units due to acute myocardial infarction. This was a retrospective cohort study based on the medical information mart for intensive care IV database involving patients admitted to intensive care units due to acute myocardial infarction. Patients were classified as low UO (LUO), high UO (HUO), and middle UO with a first 24-h UO below 800ml, over 2500ml, or in between, respectively. The primary outcome was in-hospital mortality and the secondary outcome was 1-year mortality. A total of 4337 patients were involved. Taking middle UO group as reference, after adjusting for confounders including age, gender, height, weight, comorbidity, occurrence of cardiogenic shock, revascularization, blood pressure, creatinine, N-terminal pro-brain natriuretic peptide, and use of loop diuretics, LUO was independently associated with higher in-hospital mortality [odds ratio 4.05, 95% confidence interval (CI): 3.12-5.26], while HUO was an independent protective factor (odds ratio 0.52, 95% CI: 0.35-0.77). In the multivariant Cox regression model, LUO was an independent risk factor for 1-year mortality (hazard ratio 2.65, 95% CI: 2.16-3.26), while HUO did not show significant association. In patients admitted to intensive care units due to acute myocardial infarction, first 24-h UO <800ml was a strong predictor for higher in-hospital and 1-year mortality, while first 24-h UO over 2500ml was associated with lower in-hospital mortality but not long-term mortality.

Promoting fluid intake to increase urine volume for kidney stone prevention: Protocol for a randomized controlled efficacy trial of the sipIT intervention

BackgroundRisk of kidney stone recurrence can be reduced by increasing fluid intake and urine production but most patients fail to adhere to recommended clinical guidelines. Patients have indicated that common barriers to fluid intake include a lack of thirst, forgetting to drink, and not having access to water. We developed the sipIT intervention to support patients' fluid intake with semi-automated tracking (via a mobile app, connected water bottle and a smartwatch clockface that detects drinking gestures) and provision of just-in-time text message reminders to drink when they do not meet the hourly fluid intake goal needed to achieve the recommended volume. This trial evaluates the efficacy of sipIT for increasing urine output in patients at risk for recurrence of kidney stones. Method/designAdults with a history of kidney stones and lab-verified low urine production (<2 L/day) will be randomly assigned to receive either usual care (education and encouragement to meet fluid intake guidelines) or usual care plus the sipIT intervention. The primary outcome is 24-h urine volume; secondary outcomes include urinary supersaturations, past week fluid intake, and experienced automaticity of fluid intake. Outcomes will be assessed at baseline, 1 month, 3 months, and 12 months. ConclusionsThe sipIT intervention is the first to prompt periodic fluid intake through integration of just-in-time notifications and semi-automated tracking. If sipIT is more efficacious than usual care, this intervention provides an innovative treatment option for patients needing support in meeting fluid intake guidelines for kidney stone prevention.

Benefits of Preserving Residual Urine Output in Patients Undergoing Maintenance Haemodialysis.

Chronic kidney disease is a widespread medical problem that leads to higher morbidity, mortality, and a decrease in the overall well-being of the general population. This is especially expressed in patients with end-stage renal disease (ESRD) undergoing maintenance haemodialysis. Several variables could be used to evaluate those patients' well-being and mortality risk. One of them is the presence of residual urine output. The study was conducted on 485 patients treated with maintenance haemodialysis. After enrollment in the study, which consisted of medical history, physical examination, hydration assessment, and blood sampling, each patient was followed up for 24 months. We used residual urine output (RUO) as a measure of residual renal function (RRF). The entire cohort was divided into 4 subgroups based on the daily urinary output (<=100mL per day, >100mL to <=500mL, >500mL to <=1000mL and >1000mL). The data show that the mortality rate was significantly higher in groups with lower RUO, which was caused mainly by cardiovascular events. Also, patients with higher RUO achieved better sodium, potassium, calcium, and phosphate balance. They were also less prone to overhydration and had a better nutritional status. Preserved RRF also had a positive impact on markers of cardiovascular damage, such as NT-proBNP as well as TnT. In conclusion, preserving residual urine output in ESRD patients undergoing maintenance haemodialysis is invaluable in reducing their morbidity and mortality rates and enhancing other favourable parameters of those patients.

Identifying the main predictors of urine output in autosomal-dominant polycystic kidney disease (ADPKD) patients taking tolvaptan.

Few works have analyzed factors associated with urine output in ADPKD patients taking tolvaptan (TVP). We selected 24-h urine samples from ADPKD patients treated withTVP. Urine osmolality/creatinine ratio was used as estimator of urinary osmolar load. We included 127 urine samples from 61 patients. After TVP, urine output doubled with a parallel reduction in urine solute concentration. However, when expressed as urine solute/creatinine ratios, no significant changes were observed. Daily osmolar load and osmolality/creatinine ratio did not change significantly. Before TVP, urine output was positively correlated with body weight and urine osmolality/creatinine ratio and negatively with eGFR, urine morning osmolality, and 24-h urine-calculated osmolality. After TVP, urine output was positively correlated with body weight, eGFR and negatively with age. There was a poor correlation with urine-calculated osmolality. We constructed a predictor model using mixed-effects modeling and we found that urine output was related to lower age, higher body weight, higher eGFR, and greater doses of TVP. When body weight was removed, urine output was also related to male sex and a higher daily osmolar excretion. Equation of prediction was: Urine output (mL/day) = 2771-52.9 × Age (years) + 58.4 × Weight (kg) + 18.7 × eGFR (mL/min) + 870 (if TVP = 90/30mg) + 517 (if TVP = 60/30mg). Patients taking TVP will undergo an increase about twice in urine production from baseline. Greater doses of TVP cause a progressive increase in urine production. GFR, age, and body weight are the main predictors of future urine output in patients taking TVP.

A comparative study of hemodynamic stability through intraoperative fluid administration guided by stroke volume variation assessment versus conventional parameters in terms of inferior vena cava diameter and collapsibility index during spine surgery

Stroke volume variation (SVV) is a naturally occurring phenomenon, often used by anesthesiologists for hemodynamic response to intra-operative fluid administration. In a mechanically ventilated patient under general anesthesia, the arterial pulse pressure rises during inspiration and falls during expiration due to changes in intra-thoracic pressure secondary to positive pressure ventilation. : In this open labelled, parallel group, randomized controlled trial, we investigated the role of using SVV as a marker for optimal intra-operative fluid therapy versus the conventional parameters of hemodynamic monitoring i.e., blood pressure, pulse rate and urine output in patients undergoing major spinal surgery in prone position. It was a single centre study and each group consisted of 35 patients in the age group of 18 – 50 years having ASA grade I status and without any previous comorbidities. SVV was maintained between 10 to 13% and Non-Invasive Blood Pressure (NIBP) and pulse rate maintained within 20% of baseline pre-induction values. Ringer’s lactate solution was chosen as fluid therapy in both groups. : The study showed that the total amount of fluid infused to either group had no statistically significant difference; however, the change in Inferior vena cava maximum diameter (IVCmax) in patients of the SVV monitored group was significantly lower than the conventional arm, for a given amount of fluid in either group. (Levene’s test for equality of variance F = 45.46, test statistics for equality of means t = 3.86; p = 0.001) Moreover, those patients who were maintained on lower margin of SVV range had a remarkable decrease of collapsibility index of IVC compared to pre-operative values. (Spearman’s rank correlation r = 0.533; p = 0.001) Thus, SVV proves to be a surrogate marker of administering intravenous fluid per-operatively maintaining euvolemic status as reflected by subsequent IVC collapsibility index (CI) values obtained in patients undergoing spinal surgery.

Metolazone Versus Intravenous Chlorothiazide for Decompensated Heart Failure Sequential Nephron Blockade: A Retrospective Cohort Study

BackgroundMetolazone and intravenous (IV) chlorothiazide are commonly used diuretics for sequential nephron blockade (SNB) in patients with acute decompensated heart failure (ADHF). Previous studies suggest metolazone may be comparable with chlorothiazide in terms of efficacy and safety. The objective of this study was to determine whether IV chlorothiazide is superior to metolazone in increasing net urine output (UOP) of hospitalized patients with ADHF. Methods and ResultsThis retrospective cohort study included hospitalized patients with ADHF and evidence of loop diuretic resistance in a tertiary academic medical center. The primary end point was the change in net 24-hour UOP in patients treated with IV chlorothiazide compared with metolazone. The relative cost of chlorothiazide doses and metolazone doses administered during SNB was a notable secondary end point. The median change in net 24-hour UOP in the IV chlorothiazide group was –1481.9 mL (interquartile range –2696.0 to –641.0 mL) and –1780.0 mL (interquartile range –3084.5 to –853.5 mL) in the metolazone group (P = .05) across 220 hospital encounters. The median cost of chlorothiazide and metolazone doses used during SNB was $360 and $4, respectively (P < .01). ConclusionsChlorothiazide was not superior to metolazone in changing the net 24-hour UOP of patients with ADHF and loop resistance. Preferential metolazone use in SNB is a potential cost-saving measure.

MO006: Identifying the Main Predictors of Urine Output in Autosomal Dominant Polycystic Kidney Disease (ADPKD) Patients taking Tolvaptan

Abstract BACKGROUND AND AIMS Tolvaptan (TVP) blocks vasopressin V2 receptors causing severe polyuria. Few works have analyzed factors associated with urine output in autosomal dominant polycystic kidney disease (ADPKD) patients taking TVP. METHOD We selected 24 h urine samples from ADPKD patients treated with TVP. Urine osmolality/creatinine ratio was used as estimator of urine daily osmolar load. RESULTS We included 122 urine samples from 54 patients. After TVP, urine output doubled with a parallel reduction in solutes in urine with parallel reduction in urine solute concentration. However, when they were expressed as urine solute/creatinine ratios, no significant changes were observed. Daily osmolar load and osmolality/creatinine ratio did not change significantly. Before TVP, urine output was positively correlated with body weight and urine osmolality/creatinine ratio and negatively with estimated glomerular filtration rate (eGFR), urine morning osmolality and 24 h urine calculated osmolality. After TVP, urine output was positively correlated with body weight, eGFR and negatively with age. There was a poor correlation with urine calculated osmolality. We built a predictor model using general linear modeling, and we found that urine output was related to lower age, higher body weight, higher eGFR and greater doses of TVP. When body weight was removed, urine output was also related to male sex and higher daily osmolar excretion. CONCLUSION Patients taking TVP will undergo an increase about twice in urine production from baseline. Greater doses of TVP cause a progressive increase in urine output independent of renal function. GFR and specially age and body weight are the most important predictors of future urine output in patients taking TVP.

Effects of continuous goal-directed analgesia on fluid resuscitation of massive burn patients during shock

Effects of continuous goal-directed analgesia on fluid resuscitation of massive burn patients during shock

MO130GLOMERULAR FILTRATION RATE IS THE MAIN PREDICTOR OF URINE OUTPUT IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD) PATIENTS TREATED WITH TOLVAPTAN

Abstract Background and Aims Tolvaptan was approved to treat autosomal dominant polycystic kidney disease (ADPKD) to slow the rate of kidney growth and renal function decline. Tolvaptan blocks the V2 vasopressin receptor in renal collecting ducts and distal nephron causing intense polyuria. Few authors have analyzed what factors influence the volume of diuresis in patients taking tolvaptan. Method We have analyzed the influence of solute excretion and glomerular filtration rate, besides age and gender as predictors of urine output, using multivariable analysis. In concret, we have searched the importance of osmolar excretion as predictor of volume of diuresis. Results We studied 24 h-urine samples from 18 ADPKD patients on treatment with tolvaptan, who had received the three doses: 45/15, 60/30 and 90/30 mg. Each patient was represented once per dose, for a total of 54 urine samples (Table 1). Tolvaptan increased urine volume, which was roughly doubled, and roughly halved urine solute concentrations expressed by volume and calculated osmolality. By contrast, solute concentrations expressed as ratios with creatinine remained constant as did osmolality corrected with urinary creatinine, indicating that there was no change in solute excretion after tolvaptan. Urine volume was correlated with serum creatinine (Rho= -0.36, p= 0.008), urinary creatinine (Rho = -0.29, p = 0.034) and GFR-MDRD4 (Rho = 0.44, p= 0.001). Urine volume was correlated with calculated daily osmolar excretion in Osm/day (Rho = 0.76, p &amp;lt;0.001). Urine volume was not correlated with calculated urinary osmolality in mOsm/Kg (Rho= -0.04, p= 0.77) or as urinary osmolality/creatinine ratio (Rho= 0.23, p= 0.1). Correlation of urine volume with osmolar excretion was lost when urine volume was removed from the predictor variable. Urine volume was additionally not correlated with urinary urea o sodium concentrations nor their solute/creatinine ratios, and although it was correlated with urinary potassium concentration (Rho = -0.33, p=0.014), it was not correlated with potassium/creatinine ratio. We also performed a linear regression analysis searching predictors of urine volume. Only GFR and the osmolality/creatinine ratio were significant predictors of urine volume (urine volume= 55.35 x GFR + 4.74 x Osmolality/Cr; r2= 0.41, p&amp;lt;0.001) but individual solute assessments or tolvaptan dose did not predict urine volume. Conclusions Therefore, urine volume after initiating tolvaptan in patients with ADPKD is influenced mainly by the degree of renal function. There might also be a contribution of urinary solute load but it can not be studied using total solute excretion due to collinearity. We propose that the urinary solute/creatinine ratio and osmolality/creatinine ratio should be used to search for predictors of urine output in patients on tolvaptan.

The Myth of Metolazone-Does Dose Timing with Loop Diuretics Matter?

Background There is a lack of evidence to support dosing of metolazone for sequential nephron blockade. The ideal frequency of metolazone administration as well as whether administration 30 to 60 minutes prior to the loop diuretic is warranted is unknown. This study assessed the frequency and timing of dosing of metolazone for differences in effectiveness and safety in combination with loop diuretic therapy in patients with acute decompensated heart failure (ADHF). Methods This was a single center, retrospective cohort study including adult subjects admitted for ADHF who were thiazide diuretic naive and received intravenous loop diuretic monotherapy prior to metolazone administration. Subgroup analyses were conducted based on timing of administration of metolazone 1) less than 30 minutes, 2) 30-60 minutes, and 3) greater than 60 minutes prior to the next loop diuretic dose as well as the frequency of metolazone dosing (intermittent, daily, or twice daily). The primary endpoint was net change in weight with net urine output as a secondary endpoint. Safety endpoints included an increase in serum creatinine (SCr) by >0.5 mg/dL from baseline, hypokalemia, hypomagnesemia, hyponatremia, and change in systolic blood pressure. Results We studied 174 patients with a median age of 69 years, median ejection fraction 40%, and median baseline SCr of 1.65 mg/dL. There was no difference in net change in weight, hypokalemia, hypomagnesemia, or change in systolic blood pressure among dosing strategies. The median net urine output in patients dosed intermittently, daily, or twice daily was -3845 mL, -5339 mL, and -6218 mL, respectively (p=0.05). Among patients receiving metolazone less than 30 minutes, 30-60 minutes, and over 60 minutes prior to the loop diuretic, an increase in SCr from baseline occurred in 36.7%, 17.1%, and 16.5%, respectively (p=0.045), and hyponatremia occurred in 40%, 48.6%, and 22%, respectively (p=0.006). An increase in SCr from baseline occurred in 29.9%, 11.4%, and 16.7% of patients receiving intermittent, daily, or twice daily dosing, respectively (p=0.015). Conclusions No dosing strategy of metolazone appeared to be more effective, although concurrent administration with loop diuretics was associated with more worsening renal function and hyponatremia. These results suggest that administering metolazone at least 60 minutes prior to loop diuretics may be safer and still efficacious. Larger prospective studies are needed to confirm these results.

Acute kidney injury following resection of hepatocellular carcinoma: prognostic value of the acute kidney injury network criteria

Acute kidney injury (AKI) is associated with increased morbidity and mortality after liver resection. Patients with hepatocellular carcinoma (HCC) have a higher risk of AKI owing to the underlying association between hepatic and renal dysfunction. Use of the Acute Kidney Injury Network (AKIN) diagnostic criteria is recommended for patients with cirrhosis, but remains poorly studied following liver resection. We compared the prognostic value of the AKIN creatinine and urine output criteria in terms of postoperative outcomes following liver resection for HCC. All patients who underwent a liver resection for HCC from January 2010 to June 2016 were included. We used AKIN urine output and creatinine criteria to assess for AKI within 48 hours of surgery. Eighty liver resections were performed during the study period. Cirrhosis was confirmed in 80%. Median hospital stay was 9 (interquartile range 7–12) days, and 30-day mortality was 2.5%. The incidence of AKI was higher based on the urine output than on the creatinine criterion (53.8% v. 20%), and was associated with prolonged hospitalization and 30-day postoperative mortality when defined by serum creatinine (hospital stay: 11.2 v. 20.1 d, p = 0.01; mortality: 12.5% v. 0%, p < 0.01), but not urine output (hospital stay: 15.6 v. 10 d, p = 0.05; mortality: 2.3% v. 2.7%, p > 0.99). The urine output criterion resulted in an overestimation of AKI and compromised the prognostic value of AKIN criteria. Revision may be required to account for the exacerbated physiologic postoperative reduction in urine output in patients with HCC.

Routine Indwelling Urethral Catheterization in Acute Heart Failure Patients Is Associated With Increased Urinary Tract Complications Without Improved Heart Failure Outcomes.

Indwelling urethral catheters (IUC) are routinely inserted for the purpose of monitoring urine output in patients with acute heart failure (AHF). The benefit of IUC in patients capable of complying with urine collection protocols is unclear, and IUC carry multiple risks. This study describes the impact of IUC on AHF treatment.Methods and Results:A total of 540 records were retrospectively analyzed. After exclusion criteria were applied, 316 patients were propensity matched to establish groups of 100 AHF patients who either did (IUC(+)) or did not receive an IUC (IUC(-)) upon admission. Hospital length of stay (9 vs. 7 days), in-hospital urinary complications (24 vs. 5%), and 1-year urinary tract infection rate (17 vs. 6%; HR, 3.145; 95% CI: 1.240-7.978) were significantly higher in the IUC(+) group (P<0.05 for all). There were no differences in 30-day rehospitalization (6 vs. 6%; HR, 0.981; 95% CI: 0.318-3.058; P=0.986) or major adverse cardiac/cerebrovascular events at 1 year (37 vs. 32%, HR, 1.070; 95% CI: 0.636-1.799; P=0.798). Based on this retrospective analysis, the routine use of IUC may increase length of stay and UTI complications in AHF patients without reducing the risk for major cardiovascular and cerebrovascular events or 30-day rehospitalization rate.

Efficacy of sequential nephron blockade with intravenous chlorothiazide to promote diuresis in cardiac intensive care infants.

Sequential nephron blockade using intravenous chlorothiazide is often used to enhance urine output in patients with inadequate response to loop diuretics. A few data exist to support this practice in critically ill infants. We included 100 consecutive patients <1 year of age who were administered intravenous chlorothiazide while receiving furosemide therapy in the cardiac ICU in our study. The primary end point was change in urine output 24 hours after chlorothiazide administration, and patients were considered to be responders if an increase in urine output of 0.5 ml/kg/hour was documented. Data on demographic, clinical, fluid intake/output, and furosemide and chlorothiazide dosing were collected. Multivariable regression analyses were performed to determine variables significant for increase in urine output after chlorothiazide administration. The study population was 48% male, with a mean weight of 4.9±1.8 kg, and 69% had undergone previous cardiovascular surgery. Intravenous chlorothiazide was initiated at 89 days (interquartile range 20-127 days) of life at a dose of 4.6±2.7 mg/kg/day (maximum 12 mg/kg/day). Baseline estimated creatinine clearance was 83±42 ml/minute/1.73 m2. Furosemide dose before chlorothiazide administration was 2.8±1.4 mg/kg/day and 3.3±1.5 mg/kg/day after administration. A total of 43% of patients were categorised as responders, and increase in furosemide dose was the only variable significant for increase in urine output on multivariable analysis (p<0.05). No graphical trends were noted for change in urine output and dose of chlorothiazide. Sequential nephron blockade with intravenous chlorothiazide was not consistently associated with improved urine output in critically ill infants.

Does Furosemide Increase Oxidative Stress in Acute Kidney Injury?

Furosemide, a loop diuretic, is used to increase urine output in patients with acute kidney injury (AKI). It remains uncertain whether the benefits of furosemide in AKI outweigh its potential harms. We investigated if furosemide influenced oxidative stress in 30 critically ill patients with AKI by measuring changes in F2-isoprostanes (F2-IsoPs), markers of in vivo oxidative stress, in plasma and urine following intravenous furosemide. Urine F2-IsoPs were higher in sepsis (p = 0.001) and increased in proportion to urine furosemide (p = 0.001). The furosemide-induced increase in urine F2-IsoPs differed depending on AKI severity (p < 0.001) and was greatest in those with the most severe AKI. Furosemide had no effect on plasma F2-IsoPs. We demonstrate for the first time that furosemide increases renal oxidative stress in AKI and find that patients with the most severe AKI-to whom the largest doses are likely to be administered-showed the greatest increase in oxidative stress. These findings lead to the hypothesis that the common practice of administering high-dose furosemide to convert oliguric to nonoliguric AKI may induce harmful oxidative stress in the kidneys, and an adequately powered, randomized controlled trial is required to determine if clinical benefits of this dosing strategy justify its potential harms. Antioxid. Redox Signal. 26, 221-226.

Dopamine and Nesiritide Disappoint in Acute HF with Renal Dysfunction

Findings from small physiological studies suggest that both low-dose dopamine and B-type natriuretic peptide (BNP) may enhance urine output in patients with acute heart failure (HF) and impaired kidney function without further adverse renal effects. In a trial sponsored by the National Heart, Lung, and Blood Institute, investigators compared low-dose dopamine, low-dose nesiritide (a recombinant BNP), and placebo in 360 patients with acute decompensated HF and concomitant renal dysfunction (median age, 70; 73% …

Effects of Nesiritide and Predictors of Urine Output in Acute Decompensated Heart Failure: Results From ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure)

This study sought to determine if nesiritide increases diuresis in congestive heart failure patients. In the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure), 7,141 patients hospitalized with acute decompensated heart failure (ADHF) were randomized to receive nesiritide or placebo for 24 to 168 h, in addition to standard care. There were minimal effects of nesiritide on survival, future hospitalizations, and symptoms. However, whether or not nesiritide increases diuresis in ADHF patients is unknown. Urine output was measured in 5,864 subjects; of these, 5,320 received loop diuretics and had dose data recorded. Loop diuretics other than furosemide were converted to furosemide equivalent doses. A total of 4,881 patients had complete data. We used logistic regression models to identify the impact of nesiritide on urine output and the factors associated with high urine output. Median (25th, 75th percentiles) 24-h urine output was 2,280 (1,550, 3,280) ml with nesiritide and 2,200 (1,550, 3,200) ml with placebo (p = NS). Loop diuretic dose (furosemide equivalent) was 80 (40, 140) mg with both nesiritide and placebo. Diuretic dose was a strong predictor of urine output. Other independent predictors included: male sex, greater body mass index, higher diastolic blood pressure, elevated jugular venous pressure, recent weight gain, and lower blood urea nitrogen. The addition of nesiritide did not change urine output. None of the interaction terms between nesiritide and predictors affected the urine output prediction. Nesiritide did not increase urine output in patients with ADHF. Higher diuretic dose was a strong predictor of higher urine output, but neurohormonal activation (as evidenced by blood urea nitrogen concentration) and lower blood pressure limited diuresis.

The Effect of Continuous Infusion Loop Diuretics in Patients With Acute Decompensated Heart Failure With Hypoalbuminemia

Hypoalbuminemia is believed to decrease diuretic effectiveness and contribute to diuretic resistance that is observed in patients with nephrotic syndrome. Hypoalbuminemia is also seen in patients with acute decompensated heart failure (ADHF). However, the role of hypoalbuminemia on the effectiveness of continuous infusion diuretics in patients with ADHF is not known. To evaluate hypoalbuminemia (albumin ≤ 3 g/dL) and diuretic effectiveness, we performed a retrospective study in 162 patients admitted to a tertiary care center for treatment of ADHF over a 3-year period. All patients received continuous infusion diuretic for at least a 2-day time period. A total of 33 patients were determined to have hypoalbuminemia. Average net urine output over a 2-day study period was similar between patients with and without hypoalbuminemia (-1462 ± 1734 vs -1233 ± 1560 mL, P = .46, respectively). In addition, diuretic doses (furosemide equivalent/24 hours) were similar between the 2 groups (788 ± 671 vs 778 ± 713 mg, P = .91, respectively) as was baseline serum creatinine (1.6 ± 0.6 vs 1.6 ± 0.6 mg/dL, P = .5, respectively). Overall, hypoalbuminemia did not decrease the diuretic effectiveness when measured by the net urine output in patients receiving continuous infusion diuretics for the treatment of ADHF.

Clinical and molecular genetic analysis of a new mutation in children with Wolfram syndrome: A case report

A 12‑year‑old Chinese girl presented with gradual vision loss and insulin‑dependent diabetes mellitus and was suspected to suffer from Wolfram syndrome (WFS). A series of clinical examinations were performed, as well as direct DNA sequencing to screen the entire coding region of the WFS1 gene in the patient's family, including her parents and a brother. Ophthalmological examination revealed counting fingers/10cm in the right eye and hand motions/10cm in the left eye. Ophthalmoscopical examination identified bilateral optic atrophy without any signs of diabetic retinopathy. A hearing test was performed and revealed that the hearing ability for high frequency sounds was decreased. Urinary output in 24h was >5,000ml. In addition, a base substitution at c.2411T>C (Leu804Pro) in exon8 was identified which was homozygous with the patient and heterozygous with the healthy parents and the brother. In the present case, a neuroophthalmology consult performed in the early stages of the disease was crucial for early diagnosis. In addition, this case study highlights the importance of performing a hearing test as well as collecting and analyzing 24‑h urine output in patients presenting with juvenile diabetes mellitus patients and optic atrophy without any signs of diabetic retinopathy.

Effect of Albumin on Diuretic Response to Furosemide in Patients With Hypoalbuminemia

Albumin is broadly prescribed for critically ill patients although it does not have a mortality benefit over crystalloids. One common use of albumin is to promote diuresis. Objectives To compare urine output in patients treated with furosemide with and without albumin and to assess other variables possibly associated with enhanced diuresis. A retrospective study was conducted on patients in a medical intensive care unit who received furosemide therapy as a continuous infusion with and without 25% albumin for more than 6 hours. Primary end points were urine output and net fluid loss. A total of 31 patients were included in the final analysis. Mean urine output in patients treated with furosemide alone did not differ significantly from output in patients treated with furo-semide plus albumin at 6, 24, and 48 hours: mean output, 1119 (SD, 597) mL vs 1201 (SD, 612) mL, P = .56; 4323 (SD, 1717) mL vs 4615 (SD, 1741) mL, P = .42; and 7563 mL (SD, 2766) vs 7432 (SD, 2324) mL, P = .94, respectively. Additionally, net fluid loss did not differ significantly between the 2 groups at 6, 24, and 48 hours. Higher concentrations of serum albumin did not improve urine output. The only independent variable significantly associated with enhanced urine output at 24 and 48 hours was increased fluid intake. Addition of albumin to a furosemide infusion did not enhance diuresis obtained with furosemide alone in critically ill patients.

Effect of the Volume of Fluids Administered on Intraoperative Oliguria in Laparoscopic Bariatric Surgery

To determine whether intraoperative fluid management affects urine output in patients undergoing laparoscopic bariatric operations. Randomized controlled trial. Academic tertiary referral center. Morbidly obese patients scheduled to undergo laparoscopic bariatric procedures. Patients were randomly assigned to receive intraoperatively high (10 mL/kg/h, n=55) or low (4 mL/kg/h, n=52) amounts of Ringer lactate solution. The primary end point was urine output. Secondary end points were postoperative creatinine serum concentration and complication rate. Significantly more fluids were administered intraoperatively to patients in the high-volume group compared with the low-volume group (P<.001). Regardless of the amount of fluids administered intraoperatively, low urine outputs (median [range], 100 [15-1050] mL in the high-volume group vs 107 [25-500] mL in the low-volume group; P=.34) were documented and were not significantly different. The mean creatinine serum concentration was within normal range at all times and was not significantly different between the groups (P=.68). The number of patients with complications was nonsignificantly lower in the low-volume group compared with the high-volume group (7 vs 10 patients, respectively; P=.60). In patients undergoing laparoscopic bariatric surgery, intraoperative urine output is low regardless of the use of relatively high-volume fluid therapy. The results suggest that we should reconsider the common practice to administer intraoperative fluids in response to low urine output. Further studies are required to evaluate these data in other surgical patient populations. Trial Registration clinicaltrials.gov Identifier: NCT00753402.