Renal actions of dopamine
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor of Medicine
- University of Rochester School of Medicine and Dentistry
Dopamine is synthesized within the kidney in the proximal tubule from circulating L-dopa, via the enzyme L-amino acid decarboxylase [1-3]. There are also renal nerves that contain dopamine, although the physiologic significance of these nerves is unclear.
The renal actions of dopamine are discussed here. The use of dopamine in patients with shock is presented elsewhere. (See "Use of vasopressors and inotropes".)
Circulating and locally formed dopamine can affect both sodium excretion and renal hemodynamics via activation of the DA1 and DA2 receptors .
Natriuresis — Dopamine is a natriuretic hormone, increasing sodium excretion by diminishing reabsorption, primarily in the proximal tubule [1,2,4,5]. This effect of dopamine appears to involve both of the steps involved in transtubular sodium transport:
●Dopamine, acting via the generation of cyclic AMP, decreases the activity of the Na-H exchanger in the luminal membrane, a transporter that plays an important role in the entry of filtered sodium into the cell .
- Denton MD, Chertow GM, Brady HR. "Renal-dose" dopamine for the treatment of acute renal failure: scientific rationale, experimental studies and clinical trials. Kidney Int 1996; 50:4.
- Seri I, Kone BC, Gullans SR, et al. Influence of Na+ intake on dopamine-induced inhibition of renal cortical Na(+)-K(+)-ATPase. Am J Physiol 1990; 258:F52.
- Carey RM. Theodore Cooper Lecture: Renal dopamine system: paracrine regulator of sodium homeostasis and blood pressure. Hypertension 2001; 38:297.
- Steinhausen M, Weis S, Fleming J, et al. Responses of in vivo renal microvessels to dopamine. Kidney Int 1986; 30:361.
- Olsen NV, Hansen JM, Ladefoged SD, et al. Renal tubular reabsorption of sodium and water during infusion of low-dose dopamine in normal man. Clin Sci (Lond) 1990; 78:503.
- Felder CC, Campbell T, Albrecht F, Jose PA. Dopamine inhibits Na(+)-H+ exchanger activity in renal BBMV by stimulation of adenylate cyclase. Am J Physiol 1990; 259:F297.
- Krishna GG, Danovitch GM, Beck FW, Sowers JR. Dopaminergic mediation of the natriuretic response to volume expansion. J Lab Clin Med 1985; 105:214.
- Satoh T, Cohen HT, Katz AI. Intracellular signaling in the regulation of renal Na-K-ATPase. I. Role of cyclic AMP and phospholipase A2. J Clin Invest 1992; 89:1496.
- Szerlip HM. Renal-dose dopamine: fact and fiction. Ann Intern Med 1991; 115:153.
- Lauschke A, Teichgräber UK, Frei U, Eckardt KU. 'Low-dose' dopamine worsens renal perfusion in patients with acute renal failure. Kidney Int 2006; 69:1669.
- Thompson BT, Cockrill BA. Renal-dose dopamine: a siren song? Lancet 1994; 344:7.
- Alexander RW, Gill JR Jr, Yamabe H, et al. Effects of dietary sodium and of acute saline infusion on the interrelationship between dopamine excretion and adrenergic activity in man. J Clin Invest 1974; 54:194.
- Hansell P, Fasching A. The effect of dopamine receptor blockade on natriuresis is dependent on the degree of hypervolemia. Kidney Int 1991; 39:253.
- Flis RS, Scoblionco DP, Bastl CP, Popovtzer MM. Dopamine-related polyuria in patients with gram-negative infection. Arch Intern Med 1977; 137:1547.
- Polansky D, Eberhard N, McGrath R. Dopamine and polyuria. Ann Intern Med 1987; 107:941.
- Vargo DL, Brater DC, Rudy DW, Swan SK. Dopamine does not enhance furosemide-induced natriuresis in patients with congestive heart failure. J Am Soc Nephrol 1996; 7:1032.
- Singer I, Epstein M. Potential of dopamine A-1 agonists in the management of acute renal failure. Am J Kidney Dis 1998; 31:743.
- Allison NL, Dubb JW, Ziemniak JA, et al. The effect of fenoldopam, a dopaminergic agonist, on renal hemodynamics. Clin Pharmacol Ther 1987; 41:282.