The case against renal dose dopamine in the pediatric intensive care unit.

The use of dopamine for the treatment of renal insufficiency has become a controversial issue. Dopamine exerts its effects on the kidneys through activity on the catecholamine receptors and by its diuretic and natriuretic properties. Utilization of renal dose dopamine to increase renal blood flow has been considered beneficial for preservation of renal function for over 30 years. The hypothesis proposed was that increasing urine volume must indicate improving renal function, particularly in oliguric patients. However, recent clinical trials in adult and pediatric patients have not only failed to demonstrate any benefit, but have also suggested that this therapy may actually have detrimental effects. This article reviews basic pharmacology and physiologic effects and the potential adverse effects of "renal dose dopamine." It also examines the results of clinical trials, in both pediatric and adult patients, that evaluated its usefulness for the treatment of renal insufficiency.