Diuretic effect of co-administration of furosemide and albumin in comparison to furosemide therapy alone: An updated systematic review and meta-analysis

Background It has been a matter of much debate whether the co-administration of furosemide and albumin can achieve better diuresis and natriuresis than furosemide treatment alone. There is inconsistency in published trials regarding the effect of this combination therapy. We, therefore, conducted this meta-analysis to explore the efficacy of furosemide and albumin co-administration and the factors potentially influencing the diuretic effect of such co-administration. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, Medline, and Cochrane databases. Prospective studies with adult populations which comparing the effect of furosemide and albumin co-administration with furosemide alone were included. The outcomes including diuretic effect and natriuresis effect measured by hourly urine output and hourly urine sodium excretion from both groups were extracted. Random effect model was applied for conducting meta-analysis. Subgroup analysis and sensitivity analysis were performed to explore potential sources of heterogeneity of treatment effects. Results By including 13 studies with 422 participants, the meta-analysis revealed that furosemide with albumin co-administration increased urine output by 31.45 ml/hour and increased urine excretion by 1.76 mEq/hour in comparison to furosemide treatment alone. The diuretic effect of albumin and furosemide co-administration was better in participants with low baseline serum albumin levels (< 2.5 g/dL) and high prescribed albumin infusion doses (> 30 g), and the effect was more significant within 12 hours after administration. Diuretic effect of co-administration was better in those with baseline Cr > 1.2 mg/dL and natriuresis effect of co-administration was better in those with baseline eGFR < 60 ml/min/1.73m2. Conclusion Co-administration of furosemide with albumin might enhance diuresis and natriuresis effects than furosemide treatment alone but with high heterogeneity in treatment response. According to the present meta-analysis, combination therapy might provide advantages compared to the furosemide therapy alone in patients with baseline albumin levels lower than 2.5 g/dL or in patients receiving higher albumin infusion doses or in patients with impaired renal function. Owing to high heterogeneity and limited enrolled participants, further parallel randomized controlled trials are warranted to examine our outcome. Registration PROSEPRO ID: CRD42020211002; https://clinicaltrials.gov/.

Diuretic Activity of Hydroalcoholic Extract of Physalis peruviana(Linn.) Leaves in Wistar Rats

Physalis is a genus of a perennial, herbaceous or annual plant, which is mostly the local plant of tropical North & South America. Few species of Physalis are widely distributed in warmer parts of world. Some species of Physalis grow in its edible fruits. One or two species occur wildly in India, while three other species are cultivated. Plant Physalis peruviana Linn. (Family: Solanaceae) is one of the important species of genus Physalis found in India, especially leaves & fruits have been traditionally used as a diuretic, muscle relaxant, in inflammation, for prevention of tooth decay & abdominal ailments throughout the world. The plant is reported to relieve hypertension, asthma, urinary problem & widely valued for its calming properties. The present study was initiated to investigate the diuretic effect of hydroalcoholic extract of Physalis peruviana (HEPP) in Wistar rats. Hydroalcoholic extract of Physalis peruviana leaves was administered at the dose of 50, 100 & 200 mg/kg,p.o. Hydrochlorothiazide (500mg/kg, p.o.) was used as a positive control in the study. The diuretic effect of the extract was evaluated by measuring the volume of urine, sodium, chloride & potassium content in the urine sample. Urine volume significantly increased at two doses of HEPP extract that is 100 & 200 mg/kg body weight in treated rats. Excretion of chloride, sodium and potassium levels were also increased (77.42 mmol/l, 85.20 mmol/l and 43.6 mmol/l respectively) by HEPP extract (200 ml/kg).The diuretic effect of the hydroalcoholic extract was similar to hydrochlorothiazide at the dose of 200 ml/kg. This study concluded that HEPP produced a notable diuretic effect which appeared to be comparable to that produced by the standard diuretic hydrochlorothiazide. The present study provides a quantitative basis for investigating the use of Physalis peruviana as a diuretic agent.

Pharmacokinetics and diuretic effect of furosemide after single intravenous, oral tablet, and newly developed oral disintegrating film administration in healthy beagle dogs

Background Furosemide, a diuretic that acts on the loop of Henle, is commonly used to treat congestive heart failure in veterinary medicine. Some owners have difficulty in administering oral tablet medication to animal patients, which leads to noncompliance, especially during long-term administration. Oral disintegrating film (ODF) has the advantages of easy administration via a non-invasive route, rapid dissolution, and low suffocating risk. The objective of this study was to research the pharmacokinetic (PK) profiles and diuretic effect of furosemide after intravenous (IV), orally uncoated tablet (OUT), and newly developed ODF administration in healthy beagle dogs. In this study, a furosemide-loaded ODF (FS-ODF) formulation was developed and five beagle dogs were administered a single dose (2 mg/kg) of furosemide via each route using a cross-over design. Results The most suitable film-forming agent was sodium alginate; thus, this was used to develop an ODF for easy drug administration. No significant differences were detected in the PK profiles between OUT and FS-ODF. In the blood profiles, the concentration of total protein was significantly increased compared to the baseline (0 h), whereas no significant difference was detected in the concentration of creatinine and hematocrit compared to the baseline. FS-ODF resulted in a similar hourly urinary output to OUT during the initial 2 h after administration. The urine specific gravity was significantly decreased compared to the baseline in each group. The peak times of urine electrolyte (sodium and chloride) excretion per hour were 1 h (IV), 2 h (OUT), and 2 h (FS-ODF). Conclusions These results suggest that the PK/PD of furosemide after administration of newly developed FS-ODF are similar to those of OUT in healthy dogs. Therefore, the ODF formulation has the benefits of ease and convenience, which would be helpful to owners of companion animals, such as small dogs (< 10 kg), for the management of congestive heart failure.

Phytochemical screening, mineral analysis and evaluation of the diuretic effect of aqueous extract of Pericopsis laxiflora from male Sprague Dawley rats

Pericopsis laxiflora is among the medicinal plants used by the traditional practitioner in the treatment of many diseases. However, data on its diuretic power are lacking. Moreover, the effect of the preparation of traditional galenic formulations on the composition of phytocompounds and essential minerals and metals is unknown. The aim of this study was to show the effect of treatment on the phytocompounds and minerals composition and to evaluate diuretic effect of Pericopsis laxiflora aqueous axtracts. The tube characterization reactions revealed flavonoids, sterols, terpenes, catechin tannins polyphenols and saponins in aqueous extracts. Gallic tannins and quinones are absent, All compounds were generally present in same proportions in two aqueous extracts. Chemical analysis of all aqueous extracts by atomic absorption spectrometry (AAS) showed effect of model extraction on minerals. Copper (0.3116 mg / 100g), magnesium (260.7 mg /100 g), selenium (0.00904 mg /100 g), zinc (4.52 mg /100 g), manganese (75.029 mg /100g) are more concentrated in maceration than a decoction. For decoction of same plant, the situation is reversed with sodium (58.6mg /100g), calcium (12670 mg/100g), iron (18.51mg/100g) and potassium (2781 mg /100g). For pharmacological investigation, 32 rats Sprague Dawley male weighing 385-433g are isolated each in metabolic cages from 6 pm to 8am and treated with 100mg/kg of Pericopsis laxiflora aqueous extracts. From 8am to 2pm the animals received only tap water in metabolic cages. The volumes of water intake and urine were not significantly different in the two groups (treated and untreated).The diuretic effect was not observed with 100mg/kg (b/w) . In addition polyphenols, flavonoids, saponins and minerals such as potassium, magnesium and selenium are indicators of the vasodilatory and cardioprotective functions of Pericopis laxiflora aqueous extracts. The prescription of these extracts in traditional medicine must take into account the toxicity of the plant associated with a calcium and manganese content. Keywords: Pericopsis laxiflora, dueresis, decocted extract, macerated extract, minerals, Rats Sprague Daweley

Diuretic Effect on Combination of Celery Herb (Apium graveolens L.) and Bay Leaf (Syzygium polyanthum W.) Ethanol Extract towards Wistar Male Mice (Rattus norvegicus L.)

Celery (Apium graveolens L.) and Bay (Syzygium polyanthum Wight) contain active compound of flavonoid which can obstruct reabsorbsion of Na and water until increase diuretic effect. This research aims to know diuretic effect combinations from celery herb and bay leaf ethanol extract 70% toward Wistar Male Mice using Lipschitz test. The research design is experimental with posttest only control group design by deviding the mice into normal group, hydrochlorothiazide group 25 mg/kg, control CMC-Na 0.5%, and combinations of celery herb (CHEE) and bay leaf ethanol extract(BLEE) treatment group. Those were made in 3 variances combinations doses which are; 1.125 mg/kg:6.25 mg/kg (combination-1), 2.25 mg/kg:12.5 mg/kg (combination-2), and 4.5 mg/kg:25 mg/kg (combination-3) and also 2 single doses of CHEE 4.5 mg/kg and BLEE 25 mg/kg. Diuretic effect is determined by a diuretic index and Lipschitz value. Urine volume is analyzed with ANOVA and continued analyzing with non parametric Kruskal-Wallis and Mann Whitney. The results of diuretic effect combinations from CHEE and BLEE showed that the three combinations have diuretic effect with value index in series from the smallest dose combinations are; 1.83, 1.86, 2.09 at 5 hours and 1.73, 1.75, 2.02 at 24 hours. Lipschitz values are 0.78, 0.79, 0.89 at 5 hours observation and 0.79, 0.79, 0.913 at 24 hours. Diuretic energy are ; 69.84%, 72.48%, 94.12% at 5 hours and 65.79%, 67.79%, 93.15% at 24 hours. Based on the test results of diuretic effects, combinations of CHEE and BLEE have diuretic effect and combination-3 which is the closest to hydrochlorothiazide.

Phytochemistry and Pharmacology of the Genus Equisetum (Equisetaceae): A Narrative Review of the Species with Therapeutic Potential for Kidney Diseases

The Equisetum genus, Equisetaceae family, is widely distributed worldwide and may be the oldest nonextinct genus on Earth. There are about 30 known species, which are very often used in traditional medicine with diverse applications. This review aimed to compile scientific reports about Equisetum species with relevant pharmacological properties and/or therapeutic potential for kidney diseases. Our bibliographic survey demonstrates that the most widespread traditional use of Equisetum is as a diuretic, followed by the treatment of genitourinary diseases (kidney diseases, urethritis, kidney stones, and others), inflammation, wound healing, rheumatic diseases, prostatitis, and hypertension. The most popular species from the Equisetum genus with medicinal use is E. arvense L., whose diuretic effect was confirmed in animal models and clinical trials. The species E. bogotense Kunth also demonstrated the beneficial effect of inducing diuresis in both experimental and clinical assays. Several other species have also been studied regarding their therapeutic potential, showing different biological actions. Regarding the chemical composition, it contains many active constituents, such as alkaloids, flavonoids, phenol, phytosterols, saponins, sterols, silicic acid, tannin, triterpenoids, and volatile oils. However, despite the widespread traditional use, many species need to be explored in detail for scientific validation of popular use. Indeed, the species of the Equisetum genus have great potential in the management of kidney disorders.