Importance of furosemide stress test in the management of cardiorenal syndrome type 1 with continuous renal replacement therapy- A case report

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Advanced knee osteoarthritis (n=60). Intervention: Periarticular triamcinolone acetonide vs. Intravenous hydrocortisone. Primary outcome: Peak isometric quadriceps strength (QS) recovery on postoperative day 3 (% change from baseline) (Mean difference 20.63 percentage points, 95% CI 2.66-38.59, p=0.02).

Q: What does this research mean for the field?

Periarticular triamcinolone injection significantly preserves early postoperative quadriceps strength compared with intravenous hydrocortisone at day 3 following total knee arthroplasty. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

M Murali; Mathini Sundaramurthy; R Ram; V Sivakumar

doi:10.4103/jdrntruhs.jdrntruhs_119_24

July 1, 2026Journal of Dr. YSR University of Health Sciences.Open Access

Importance of furosemide stress test in the management of cardiorenal syndrome type 1 with continuous renal replacement therapy- A case report

View Full Paper

Ask AI

Bookmark

Share

Figures

Why the study?

Early recognition of AKI progression is critical for effective management, and the utility of the Furosemide Stress Test in guiding treatment in CRS type 1 requires illustration.

Does a periarticular triamcinolone injection improve early postoperative quadriceps strength recovery compared to intravenous hydrocortisone in patients undergoing primary total knee arthroplasty?

Key Points

To evaluate the clinical utility of the furosemide stress test for assessing renal tubular functional integrity and guiding treatment decisions in cardiorenal syndrome type 1.
Assessed renal tubular functional integrity using the furosemide stress test in an elderly diabetic female patient with cardiorenal syndrome type 1 and KDIGO stage 1 acute kidney injury.
Initiated continuous renal replacement therapy in response to a negative diuretic challenge.
The furosemide stress test demonstrated a negative diuretic response, prompting the timely initiation of continuous renal replacement therapy.
The patient achieved full recovery of normal renal function with a daily urine output exceeding 1500 milliliters per day prior to hospital discharge.

Study Design

Type

RCT (n=60)

Blinding

Single-blind

Randomization

1:1 using STATA with a block size of four

Multicenter

No

Structured PICO

Does a periarticular triamcinolone injection improve early postoperative quadriceps strength recovery compared to intravenous hydrocortisone in patients undergoing primary total knee arthroplasty?

P

Population

60 adults aged 55 to 80 years with advanced knee osteoarthritis scheduled for primary total knee arthroplasty were randomized to receive either periarticular triamcinolone or intravenous hydrocortisone, with follow-up for 6 months.

I

Intervention

Periarticular injection of 40 mg triamcinolone acetonide combined with 20 mL of 0.5% bupivacaine and 30 mg of ketorolac, administered into surrounding soft tissue intraoperatively.

C

Comparator

Intravenous hydrocortisone (100 mg 2 hours before surgery, followed by 25 mg every 8 hours for 24 hours) plus periarticular injection of 20 mL of 0.5% bupivacaine and 30 mg ketorolac.

O

Outcome

Peak isometric quadriceps strength (QS) recovery, expressed as a percentage change from the preoperative value on postoperative day 3.surrogate

Main Result

Mean Difference: 20.63 (95% CI 2.66–38.59)

Absolute Event Rate: -43.11% vs -63.74%

p-value: p=0.02

Limitations

Small sample size
Patient blinding not possible
Single academic centre with a single surgeon
Statistically significant imbalance in the side of surgery between groups
Simultaneous comparison of both route of administration and corticosteroid agent (hydrocortisone vs triamcinolone)
Relatively small sample size
Long-term effects of corticosteroid administration beyond 6 months were not evaluated
Simultaneous comparison of both route of administration and corticosteroid agent

Implication

A single periarticular injection of triamcinolone acetonide is superior to intravenous hydrocortisone for preserving early quadriceps strength and mobility immediately after primary total knee arthroplasty.

Abstract

Early recognition of the progression of Acute kidney injury (AKI) helps in the effective management of the disease. The Furosemide Stress Test (FST) is helpful in such situations in management. FST is a simple dynamic functional test that determines renal tubular functional integrity, offering early diagnosis and prognostication of AKI. We report the utility of FST in the management of AKI (KDIGO—Kidney Disease Improving Global Outcomes) stage 1 in an elderly diabetic woman with Cardiorenal Syndrome (CRS) type 1. FST showed a negative diuretic response; hence, the patient was initiated on continuous renal replacement therapy (CRRT), and before discharge, the patient had normal renal function with a urine output of more than 1500 milliliters per day. FST helped us in the timely initiation of CRRT in the management of CRS type 1 in this patient, leading to a gratifying outcome.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Murali et al. (2026) conducted an RCT in Advanced knee osteoarthritis (n=60). Periarticular triamcinolone acetonide vs. Intravenous hydrocortisone was evaluated on Peak isometric quadriceps strength (QS) recovery on postoperative day 3 (% change from baseline) (Mean difference 20.63 percentage points, 95% CI 2.66-38.59, p=0.02).

synapsesocial.com/papers/6ad0fd263afa093ea9ad020a https://doi.org/10.4103/jdrntruhs.jdrntruhs_119_24

View Full Paper

Ask AI

Bookmark

Share

Importance of furosemide stress test in the management of cardiorenal syndrome type 1 with continuous renal replacement therapy- A case report

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Importance of furosemide stress test in the management of cardiorenal syndrome type 1 with continuous renal replacement therapy- A case report

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

More related papers

More from Journal of Dr. YSR University of Health Sciences.

Keep reading

More related papers

More from Journal of Dr. YSR University of Health Sciences.