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Query: UMLS:C0028961 (oliguria)
 1,847 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

When comparing iatrogenic inhibition with endogenous stimulation of renal prostaglandin production, the role of this mediator and modulator system for renal function becomes apparent. Renal perfusion and glomerular filtration as well as modulation of tubular function with respect to electrolyte and water excretion is significantly influenced by renal prostaglandin activity. Treatment with the prostaglandin cyclooxygenase inhibitor indomethacin reduces the endogenous creatinine clearance by about fifty percent in a state of a diminished circulatory blood volume, such as may exist during left-to-right shunting across a persistent ductus arteriosus in preterm infants. In addition, urinary electrolyte and water excretion is reduced by increased tubular absorption leading to marked oliguria. In contrast, electrolytes and water are lost in congenital renal tubular disorders associated with increased prostaglandin E2 (PGE2) activity (a so called hyperprostaglandin E syndrome). Patients with this renal disorder require a permanent high dosed indomethacin therapy. After this pharmacotherapy has brought electrolyte and water metabolism into balance, no deterioration of glomerular filtration and renal perfusion was observed. This is in accordance with the general principle that renal function only becomes dependent on the vasodilatory activity of renal prostaglandins in a stress situation resulting in the threat of hypoperfusion. It is essential to bear in mind the physiological and pathophysiological role of renal prostaglandins, when prescribing frequently administered prostaglandin cyclooxygenase inhibitors like aspirin, paracetamol or indomethacin in pediatrics. Otherwise, renal function may deteriorate or the kidney will be irreversibly damaged.
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PMID:[The significance of renal prostaglandins for kidney function in early childhood]. 360 Jun 69

Management of neonatal patent ductus arteriosus (PDA) often is resource-intensive and costly. Therefore, it is in hospitals' best interests to ensure the most cost-efficient use of associated resources. Clinical status, comorbidities, and response to prior therapy are considered in selecting the most appropriate intervention for PDA management. Currently, supportive measures (e.g., fluid restriction), surgical ligation, and pharmacologically based medical therapy are the primary treatment modalities for correcting PDA. Medical therapy, which comprises a small percentage (2.0%-5.0%)1 of overall PDA treatment expenses in the United States, consists of either of the 2 intravenous (IV) cyclooxygenase (COX) inhibitors: IV indomethacin and the newly available IV ibuprofen lysine. Although IV COX inhibitors represent a small portion of medical expenses, their benefits appear to be considerable. Pharmacoeconomic studies have evaluated indomethacin's beneficial impact on cost-effectiveness per quality-adjusted life year in PDA prophylaxis; however, no analysis to date prospectively assesses the effect of COX inhibitors on resource use or expenses in treating PDA. Such analysis is desirable and should consider efficacy and safety outcomes, impact on health care resource use and length of stay (LOS), and any differential effects of the agents' safety profiles; notably, IV indomethacin adversely affects renal and mesenteric blood flow and increases serum creatinine and oliguria significantly more than IV ibuprofen. These observations lay the foundation to conduct studies assessing the influence of these differences on resource use, LOS and expenses associated with PDA management.
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PMID:Pharmacoeconomics of Surgical Interventions vs. Cyclooxygenase Inhibitors for the Treatment of Patent Ductus Arteriosus. 2305 53