***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Studies on the role of loop diuretics in patients with acute renal failure ( ARF ) are largely retrospective , anecdotal , and poorly controlled . We report the results of a prospect i ve , r and omized , placebo-controlled , double-blind study examining the effect of loop diuretics on renal recovery , dialysis , and death in patients with ARF . METHODS Ninety-two patients with ARF were enrolled into the study . All received intravenous dopamine , 2 micrograms/kg body weight/min throughout , 20 % mannitol , 100 ml every 6 h for the first 3 days , and , in a double-blind manner , either torasemide , frusemide , or placebo , 3 mg/kg body weight i.v . every 6 h for 21 days or until renal recovery or death . RESULTS Renal recovery , the need for dialysis , and death were no different in the three groups . Patients given a loop diuretic had a significant rise in urine flow rate in the first 24 h compared to placebo ( P = 0.02 ) . Based on the urine flow rate during the first post-medication day patients were divided into two groups -- oliguric ( < 50 ml/h ) and non-oliguric ( > or = 50 ml/h ) . Non-oliguric patients had a significantly lower mortality than oliguric patients ( 43 % vs 69 % , P = 0.01 ) . However , they were less ill ( APACHE II score 17.2 vs 20.6 , P = 0.008 ) and had less severe renal failure at entry ( creatinine clearance 14 ml/min vs 4 ml/min , P < 0.0001 ) . CONCLUSION The use of loop diuretics in oliguric patients with ARF can result in a diuresis . There is no evidence that these drugs can alter outcome The results of treatment with frusemide in 105 patients with established acute renal failure admitted during the past six years were review ed and compared with control groups . Daily doses of 2,000 mg of frusemide administered from the day of admission onwards produced a significant increase in the number of patients who attained a diuresis and decreased the duration of oliguria . The reduction in the time spent in hospital and in the number of dialyses required suggests that the use of frusemide in these large doses is indicated in patients with severe established acute renal failure A r and omized study was conducted on 66 patients with acute established oliguric renal failure .  Intravenous doses of furosemide ranging from 1.5 to 6.0 mg/kg were given every 4 h to 33 of the patients ; the remaining 33 patients served as controls . A persisting diuretic response was observed in 5 treated patients and in 2 controls . Hemodialyses were required in most of them . Furosemide did not significantly modify in cured patients the mean oliguric period , the number of dialyses and the mean period of renal insufficiency Fifty-eight patients in established acute renal failure following trauma or surgery were allocated in a prospect i ve and r and om fashion to two different diuretic regimes . In the control group , 1 g frusemide was given as a single injection over four hours . In the test group , frusemide was then continued either intravenously or orally in a dose of 3 g/24 hr until a urine output of 200 ml/hr was sustained or until the plasma creatinine fell below 300 mumoles/l . Oliguria was reversed or prevented in 24 of 28 patients given sustained frusemide , but in only 2 patients given a single injection . However , the number of dialyses and duration of renal failure and mortality were not different in the two groups . The serious complication of deafness occurred in two patients and in one of them this was permanent Background The impact of diuretic usage and dosage on the mortality of critically ill patients with acute kidney injury is still unclear . Methods and Results In this prospect i ve , multicenter , observational study , 572 patients with postsurgical acute kidney injury receiving hemodialysis  were recruited and followed daily . Thirty-day postdialysis mortality was analyzed using Cox 's proportional hazards model with time-dependent covariates . The mean age of the 572 patients was 60.8±16.6 years . Patients with lower serum creatinine ( p = 0.031 ) and blood lactate ( p = 0.033 ) at ICU admission , lower predialysis urine output ( p = 0.001 ) and PaO2/FiO2 ( p = 0.039 ) , as well as diabetes ( p = 0.037 ) and heart failure ( p = 0.049 ) were more likely to receive diuretics . A total of 280 ( 49.0 % ) patients died within 30 days after acute dialysis initiation . The analysis of 30-day postdialysis mortality by fitting propensity score-adjusted Cox 's proportional hazards models with time-dependent covariates showed that higher 3-day accumulated diuretic doses after dialysis initiation ( HR = 1.449 , p = 0.021 ) could increase the hazard rate of death . Moreover , higher time-varying 3-day accumulative diuretic doses were associated with hypotension ( p<0.001 ) and less intense hemodialysis ( p<0.001 ) during the acute dialysis period . Background and Significance Higher time-varying 3-day accumulative diuretic dose predicts mortality in postsurgical critically ill patients requiring acute dialysis . Higher diuretic doses are associated with hypotension and a lower intensity of dialysis . Caution should be employed before loop diuretics are administered to postsurgical patients during the acute dialysis period CONTEXT Acute renal failure is associated with high mortality and morbidity .  Diuretic agents continue to be used in this setting despite a lack of evidence supporting their benefit . OBJECTIVE To determine whether the use of diuretics is associated with adverse or favorable outcomes in critically ill patients with acute renal failure . DESIGN Cohort study conducted from October 1989 to September 1995 . PATIENTS AND SETTING A total of 552 patients with acute renal failure in intensive care units at 4 academic medical centers affiliated with the University of California . Patients were categorized by the use of diuretics on the day of nephrology consultation and , in companion analyses , by diuretic use at any time during the first week following consultation . MAIN OUTCOME MEASURES All-cause hospital mortality , nonrecovery of renal function , and the combined outcome of death or nonrecovery . RESULTS Diuretics were used in 326 patients ( 59 % ) at the time of nephrology consultation . Patients treated with diuretics on or before the day of consultation were older and more likely to have a history of congestive heart failure , nephrotoxic ( rather than ischemic or multifactorial ) origin of acute renal failure , acute respiratory failure , and lower serum urea nitrogen concentrations . With adjustment for relevant covariates and propensity scores , diuretic use was associated with a significant increase in the risk of death or nonrecovery of renal function ( odds ratio , 1.77 ; 95 % confidence interval , 1.14 - 2.76 ) . The risk was magnified ( odds ratio , 3.12 ; 95 % confidence interval , 1.73 - 5.62 ) when patients who died within the first week following consultation were excluded . The increased risk was borne largely by patients who were relatively unresponsive to diuretics . CONCLUSIONS The use of diuretics in critically ill patients with acute renal failure was associated with an increased risk of death and nonrecovery of renal function . Although observational data prohibit causal inference , it is unlikely that diuretics afford any material benefit in this clinical setting . In the absence of compelling contradictory data from a r and omized , blinded clinical trial , the widespread use of diuretics in critically ill patients with acute renal failure should be discouraged Furosemide , a loop diuretic , is used to increase urine output in patients with acute kidney injury ( AKI ) . It remains uncertain whether the benefits of furosemide in AKI outweigh its potential harms . We investigated if furosemide influenced oxidative stress in 30 critically ill patients with AKI by measuring changes in F2-isoprostanes ( F2-IsoPs ) , markers of in vivo oxidative stress , in plasma and urine following intravenous furosemide .  Urine F2-IsoPs were higher in sepsis ( p = 0.001 ) and increased in proportion to urine furosemide ( p = 0.001 ) . The furosemide-induced increase in urine F2-IsoPs differed depending on AKI severity ( p < 0.001 ) and was greatest in those with the most severe AKI . Furosemide had no effect on plasma F2-IsoPs . We demonstrate for the first time that furosemide increases renal oxidative stress in AKI and find that patients with the most severe AKI-to whom the largest doses are likely to be administered-showed the greatest increase in oxidative stress . These findings lead to the hypothesis that the common practice of administering high-dose furosemide to convert oliguric to nonoliguric AKI may induce harmful oxidative stress in the kidneys , and an adequately powered , r and omized controlled trial is required to determine if clinical benefits of this dosing strategy justify its potential harms . Antioxid . Redox Signal . 26 , 221 - 226 OBJECTIVE To evaluate the safety and relative effectiveness of two diuretic protocol s in the intensive care unit ( ICU ) . DESIGN Prospect i ve , r and omized comparative study . PATIENTS Thirty-three cardiac and medical ICU patients with pulmonary edema or fluid overload for which aggressive diuresis was intended . INTERVENTIONS Enrolled patients were r and omized to fluid management strategies combining fluid restriction and individually adjusted diuretic therapy by either continuous or bolus infusions of furosemide , titrated to achieve negative hourly fluid balance . MEASUREMENTS AND MAIN RESULTS Cumulative intake minus output ( primary endpoint ) ; change in serum creatinine , and length of ICU and hospital stay ( secondary endpoints ) . Diuresis by either protocol was feasible , safe , and effective . The main outcome measures were not significantly different for either group managed with a st and ardized protocol . CONCLUSIONS Protocol -guided diuretic management , with individualized titration of dosage to defined physiologic endpoints can be readily and safely implemented in the ICU . Both continuous and bolus diuretic regimens appear equally effective in achieving negative fluid balance . Larger studies with a r and omized control arm are needed before these protocol s can be recommended as routine practice Purpose : Furosemide is commonly prescribed in acute kidney injury ( AKI ) . Prior studies have found conflicting findings on whether furosemide modifies the course and outcome of AKI . Methods : Pilot multi‐center r and omized blinded placebo‐controlled trial in adult patients with AKI admitted to three intensive care units . Participants were r and omly allocated to furosemide bolus and infusion or 0.9 % saline placebo . Primary endpoint was worsening AKI , defined by the RIFLE criteria . Secondary endpoints were kidney recovery , renal replacement therapy ( RRT ) and adverse events . Results : The trial was terminated after enrollment of 73 participants ( 37 to furosemide and 36 to placebo ) . Mean ( SD ) age was 61.7 ( 14.3 ) , 79.5 % were medical admissions , mean ( SD ) APACHE II score was 26.6 ( 7.8 ) , 90.4 % received mechanical ventilation and 61.6 % received vasoactives . Groups were similar at baseline . No differences were found in the proportion with worsening AKI ( 43.2 % vs. 37.1 % , p = 0.6 ) , kidney recovery ( 29.7 % vs. 42.9 % , p = 0.3 ) , or RRT ( 27.0 % s. 28.6 % , p = 0.8 ) . Adverse events , mostly electrolyte abnormalities , were more common in furosemide‐treated patients ( p < 0.001 ) . Protocol deviations were common , due often to supplementary furosemide . Conclusions : In this pilot trial , furosemide did not reduce the rate of worsening AKI , improve recovery or reduce RRT ; however , was associated with greater electrolyte abnormalities . Trial registration : Clinical Trials.gov Identifier : NCT00978354 registered September 9 , 2014 . HighlightsFurosemide is commonly prescribed to patients with AKI in ICU setting s , despite a contradictory evidence on their effectiveness and safety . This pilot RCT aim ed to evaluate the impact of furosemide in early AKI on worsening AKI , kidney recovery , and RRT use . This trial found no differences in the proportion with worsening AKI , kidney recovery , or RRT use . Adverse events , driven largely by electrolyte abnormalities , more commonly occurred in furosemide treated patients AIM To evaluate the safety and efficacy of various initial strategies of loop diuretic administration in patients with acute decompensated heart failure ( ADHF ) on diuresis , renal function , electrolyte balance and clinical out 
    Output:
    
Considering that fluid accumulation is a common issue in AKI , we speculate that patients with mild AKI are more likely to respond to furosemide challenge and the side effects of furosemide , such as oxidative stress [ 5 ] , may be overwhelmed by the reduced fluid accumulation .