Cotreatment with Furosemide and Hypertonic Saline Decreases Serum Neutrophil Gelatinase-associated Lipocalin (NGAL) and Serum Creatinine Concentrations in Traumatic Brain Injury: A Randomized, Single-Blind Clinical Trial

Acute kidney injury (aki) occurs both after traumatic brain injury (tbi) and after hypertonicsaline administration; furosemide may be useful in preventing aki indirectly. serum neutrophilgelatinase-associated lipocalin (sngal) is superior to serum creatinine (scr) in diagnosing early aki. we compared the administration of hypertonic saline plus furosemide (hts+f) versus hypertonic saline (hts), using scr and sngal to investigate kidney injury in patients with tbi. this randomized, single-blind clinical trial was conducted from august 2016 to july 2017 in a neurosurgical intensive care unit, and included patients with a glasgow coma score(gcs) 7-13 and brain edema. one group (n = 22) received hypertonic saline 5% (100 ml over 60 min then 20 ml/h) plus furosemide (40 mg over 60 min then 0.05 mg/kg per hour) for 72 h. the other group (n = 21) received only hypertonic saline 5%, in the same dose as noted above. the scr and sngal concentrations, gcs, and length of stay were measured. mean ± sd differences were -51.15 (47.07) and 9.96 (64.23) ng/ml for sngal and -0.12(0.22) and -0.005 (0.2) mg/dl for scr in hts+f group and hts group respectively (both p <0.001). the incidence of stage one aki according to improving global outcomes (kdigo) criteria was 4.5% in the hts+f group and 19.0% in the hts group (p = 0.16). hypokalemia was common in both groups. hts+f group, compared with hts group, was associated with lower concentrations of scr and sngal. incidence aki (kdigo criteria) did not have difference between groups.