***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 CONTEXT Although acute renal failure ( ARF ) is believed to be common in the setting of critical illness and is associated with a high risk of death , little is known about its epidemiology and outcome or how these vary in different regions of the world . OBJECTIVES To determine the period prevalence of ARF in intensive care unit ( ICU ) patients in multiple countries ; to characterize differences in etiology , illness severity , and clinical practice ; and to determine the impact of these differences on patient outcomes . DESIGN , SETTING , AND PATIENTS Prospect i ve observational study of ICU patients who either were treated with renal replacement therapy ( RRT ) or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001 at 54 hospitals in 23 countries . MAIN OUTCOME MEASURES Occurrence of ARF , factors contributing to etiology , illness severity , treatment , need for renal support after hospital discharge , and hospital mortality . RESULTS Of 29 269 critically ill patients admitted during the study period , 1738 ( 5.7 % ; 95 % confidence interval [ CI ] , 5.5%-6.0 % ) had ARF during their ICU stay , including 1260 who were treated with RRT . The most common contributing factor to ARF was septic shock ( 47.5 % ; 95 % CI , 45.2%-49.5 % ) . Approximately 30 % of patients had preadmission renal dysfunction . Overall hospital mortality was 60.3 % ( 95 % CI , 58.0%-62.6 % ) . Dialysis dependence at hospital discharge was 13.8 % ( 95 % CI , 11.2%-16.3 % ) for survivors . Independent risk factors for hospital mortality included use of vasopressors ( odds ratio [ OR ] , 1.95 ; 95 % CI , 1.50 - 2.55 ; P<.001 ) , mechanical ventilation ( OR , 2.11 ; 95 % CI , 1.58 - 2.82 ; P<.001 ) , septic shock ( OR , 1.36 ; 95 % CI , 1.03 - 1.79 ; P = .03 ) , cardiogenic shock ( OR , 1.41 ; 95 % CI , 1.05 - 1.90 ; P = .02 ) , and hepatorenal syndrome ( OR , 1.87 ; 95 % CI , 1.07 - 3.28 ; P = .03 ) . CONCLUSION In this multinational study , the period prevalence of ARF requiring RRT in the ICU was between 5 % and 6 % and was associated with a high hospital mortality rate Objective : According to recent research , diuretics may increase mortality in acute renal failure patients . The administration of diuretics in such patients has been discouraged . Our objective was to determine the impact of diuretics on the mortality rate of critically ill patients with acute renal failure . Design : Prospect i ve , multiple-center , multinational epidemiologic study . Setting : Intensive care units from 54 centers and 23 countries . Patients : Patients were 1,743 consecutive patients who either were treated with renal replacement therapy or fulfilled predefined criteria for acute renal failure . Interventions : Three distinct multivariate models were developed to assess the relationship between diuretic use and subsequent mortality : a ) a propensity score adjusted multivariate model containing terms previously identified to be important predictors of outcome ; b ) a new propensity score adjusted multivariate model ; and c ) a multivariate model developed using st and ard methods , compensating for collinearity . Measurements and Main Results : Approximately 70 % of patients were treated with diuretics at study inclusion . Mean age was 68 and mean Simplified Acute Physiology Score II was 47 . Severe sepsis/septic shock ( 43.8 % ) , major surgery ( 39.1 ) , low cardiac output ( 29.7 ) , and hypovolemia ( 28.2 % ) were the most common conditions associated with the development of acute renal failure . Furosemide was the most common diuretic used ( 98.3 % ) .  Combination therapy  was used in 98 patients only . In all three models , diuretic use was not associated with a significantly increased risk of mortality . Conclusions : Diuretics are commonly prescribed in critically ill patients with acute renal failure , and their use is not associated with higher mortality . There is full equipoise for a r and omized controlled trial of diuretics in critically ill patients with renal dysfunction 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 BACKGROUND Contrast nephropathy ( CN ) is a common cause of renal dysfunction that may be prevented by saline hydration and by drugs such as theophylline or furosemide . Whether oral saline hydration is as efficient as intravenous saline hydration is unknown . The preventive efficacy of theophylline and furosemide for CN remains controversial . The purpose of the current study was to evaluate the efficacy of oral saline hydration and of intravenous saline hydration plus theophylline or furosemide for the prevention of CN . METHODS We prospect ively studied 312 patients with chronic renal failure ( serum creatinine 201+/-81 micromol/l , Cockcroft clearance 37+/-12 ml/min/1.73 m(2 ) ) , who were undergoing various radiological procedures with a non-ionic , low osmolality contrast agent . Patients were r and omly assigned to four arms . In arm A , patients received 1 g/10 kg of body weight/day of sodium chloride per os for 2 days before the procedure . In arm B , patients received 0.9 % saline intravenously at a rate of 15 ml/kg for 6 h before the procedure . In arm C , patients received the same saline hydration as in arm B plus 5 mg/kg theophylline per os in one dose 1 h before the procedure . In arm D , patients received the same saline hydration as in arm B plus 3 mg/kg of furosemide intravenously just after the procedure . RESULTS Patients were well-matched with no significant differences at baseline in any measured parameters .  Acute renal failure , defined as an increase in serum creatinine of 44 micromol/l ( 0.5 mg/dl ) , occurred in 27 out of 312 patients ( 8.7 % ) . There was no significant difference between the rate of renal failure in the different arms of the study : five out of 76 ( 6.6 % ) in arm A , four out of 77 ( 5.2 % ) in arm B , six out of 80 ( 7.5 % ) in arm C and 12 out of 79 ( 15.2 % ) in arm D. No patient had fluid overload or a significant increase in blood pressure in the 2 days following the radiological procedure . The independent predictors of CN were diabetes mellitus , high baseline serum creatinine and high systolic blood pressure . CONCLUSIONS Oral saline hydration was as efficient as intravenous saline hydration for the prevention of CN in patients with stage 3 renal diseases . Furosemide and theophylline were not protective Lastly , we must point out that when hyperthermia is given together with cytotoxic drugs , as is current practice in Edinburgh , the combined treatment is associated with a definite mortality . It therefore appears to us that further controlled studies and consid_rably more data are required before hyperthermia can be accepted as having a significant role to play in cancer management . -We are , etc . , MARY DOUGLAS ALLAN 0 . LANGL AND S J. A. ORR Deparmtent of Radiotherapy , Western General Hospital , 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 Introduction In the setting of early acute kidney injury ( AKI ) , no test has been shown to definitively predict the progression to more severe stages . Methods We investigated the ability of a furosemide stress test ( FST ) ( one-time dose of 1.0 or 1.5 mg/kg depending on prior furosemide-exposure ) to predict the development of AKIN Stage-III in 2 cohorts of critically ill subjects with early AKI . Cohort 1 was a retrospective cohort who received a FST in the setting of AKI in critically ill patients as part of Southern AKI Network . Cohort 2 was a prospect i ve multicenter group of critically ill patients who received their FST in the setting of early AKI . Results We studied 77 subjects ; 23 from cohort 1 and 54 from cohort 2 ; 25 ( 32.4 % ) met the primary endpoint of progression to AKIN-III .  Subjects with progressive AKI had significantly lower urine output following FST in each of the first 6 hours ( p<0.001 ) . The area under the receiver operator characteristic curves for the total urine output over the first 2 hours following FST to predict progression to AKIN-III was 0.87 ( p = 0.001 ) . The ideal-cutoff for predicting AKI progression during the first 2 hours following FST was a urine volume of less than 200mls(100ml/hr ) with a sensitivity of 87.1 % and specificity 84.1 % . Conclusions The FST in subjects with early AKI serves as a novel assessment of tubular function with robust predictive capacity to identify those patients with severe and progressive AKI . Future studies to vali date these findings are warranted Background — The RenalGuard System , which creates high urine output and fluid balancing , may be beneficial in preventing contrast-induced acute kidney injury . Methods and Results — The Renal Insufficiency After Contrast Media Administration Trial II ( REMEDIAL II ) trial is a r and omized , multic 
    Output:
    
Intermittent furosemide administration is not associated with an increased mortality in patients with or at risk for AKI , although it may reduce mortality when used as a preventive measure .