末期慢性腎不全におけるNaおよびフロセマイド大量投与療法,とくに聴力障害について

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タイトル別名
  • Nondialytic management of end-stage chronic renal failure by sodium loading in conjunction with high-dose furosemide administration
  • マッキ マンセイ ジンフゼン ニ オケル Na オヨビ フロセマイド タイリョ

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In order to delay the introduction of dialytic procedures, 11 patients with chronic renal failure due to chronic glomerulonephritis (8 cases), chronic pyelonephritis (1 case), polycystic kidney (1 case) and bilateral renal cortical necrosis (1 case) were treated with high dose of furosemide and sodium. They were given orally. Blood urea nitrogen was decreased in four cases, and serum creatinine in two, including one case of bilateral renal cortical necrosis in whom some improvement in renal funetion was ensued. In these 6 successful cases, when serum creatinine level was 8mg /dl or more, daily urine output was increased from an average volume of 1.3L to more than 2.4L by the use of 320mg of furosemide per day and 205mEq of sodium per day. When the level was less than 8mg/dl, mean daily output of urine was increased from 0.9L to 2.0L or more by the use of 547mg of furosemide per day and 189mEq of sodium per day. In unsuccessful cases daily urine output did not reach volume described above, and mean furosemide dose and mean sodium intake were 456mg/day and 147mEq/day, respectively. These results suggest that the use of sufficient amount of sodium in concomitance with furosemide is essential to the nondialytic treatment of end-stage chronic renal failure. During the treatment, bilateral perceptive hearing loss was noted by audiometric test in all 7 cases examined. They had not been treated with any aminoglycoside antibiotics. In the control group of 8 patients of chronic renal failure maintained with hemodialysis during 1.7 to 6.2 years, there were three cases with bilateral perceptive hearing loss, and two of them had been treated with aminoglycoside. It was not decided whether this damage was due to furosemide, and if so, whether it was reversible after cessation of its administration.

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