Because of its ability to increase renal blood flow selectively through the activation of dopaminergic renal receptors, dopamine has gained in popularity for the prevention and treatment of acute renal failure although a definite demonstration of its efficacy has never been obtained. Dopamine has a range of dose responses which have been attributed to activation of different types of endothelial receptor (dopaminergic receptors, b- and a-adrenergic receptors). Dogma, rather than scientific proof, motivates the use of renal-dose dopamine. Indeed, it is known that, even at low doses, patients may have b-adrenergic receptor activation with diuresis secondary to the increase in cardiac output. Many questions concerning the use of renal doses of dopamine remain unanswered. Indeed, what is the clinical relevance of increasing cardiac output? The usefulness of this therapy in acute renal failure still needs to be demonstrated. For all these reasons, in recent years routine renal-dose dopamine administration has been challenged and further carefully designed studies have been called for. In the interval, the possible benefits or advantages of administration of dopamine for renal protection or improvement of diuresis must be weighed against potential adverse effects ( S§9.§ieLM 1992).
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