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Volume 351:2347-2349 November 25, 2004 Number 22
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Acute Renal Failure and Sepsis

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by Schrier, R. W.
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To the Editor: We are concerned that Schrier and Wang's review of septic acute renal failure (July 8 issue)1 overlooks some important data. Norepinephrine does not result in afferent arteriolar vasoconstriction when given by continuous intravenous infusion at clinically relevant doses. It actually increases the global renal blood flow, with little or no vasoconstriction,2,3 and in large-animal models of hyperdynamic sepsis, it also increases medullary renal blood flow.3 In a randomized, controlled study of hyperdynamic sepsis, norepinephrine markedly increased urinary output, as compared with dopamine,4 thus challenging the idea that norepinephrine "may contribute to and prolong the course of acute . . . [Full Text of this Article]



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