Noradrenaline and the kidney: Friends or foes?

Rinaldo Bellomo, David Di Giantomasso

Research output: Contribution to journalReview ArticleResearchpeer-review

112 Citations (Scopus)

Abstract

Septic shock, systemic inflammation and pharmacological vasodilatation are often complicated by systemic hypotension, despite aggressive fluid resuscitation and an increased cardiac output. If the physician wishes to restore arterial pressure (>80-85 mmHg), with the aim of sustaining organ perfusion pressure, the administration of systemic vasopressor agents, such as noradrenaline, becomes necessary. Because noradrenaline induces vasoconstriction in many vascular beds (visibly in the skin), however, it may decrease renal and visceral blood flow, impairing visceral organ function. This unproven fear has stopped clinicians from using noradrenaline more widely. In vasodilated states, unlike in normal circulatory conditions, however, noradrenaline may actually improve visceral organ blood flow. Animal studies show that the increased organ perfusion pressures achieved with noradrenaline improve the glomerular filtration rate and renal blood flow. There are no controlled human data to define the effects of noradrenaline on the kidney, but many patient series show a positive effect on glomerular filtration rate and urine output. There is no reason to fear the use of noradrenaline. If it is used to support a vasodilated circulation with a normal or increased cardiac output, it is likely to be the kidney's friend not its foe.

Original languageEnglish
Pages (from-to)294-298
Number of pages5
JournalCritical Care
Volume5
Issue number6
DOIs
Publication statusPublished - 1 Dec 2001
Externally publishedYes

Keywords

  • Acute kidney failure
  • Kidney
  • Norepinephrine
  • Organ blood flow
  • Septic shock

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