Noradrenaline and the kidney: friends or foes?

Crit Care. 2001 Dec;5(6):294-8. doi: 10.1186/cc1052. Epub 2001 Oct 22.


Septic shock, systemic inflammation and pharmacological vasodilatation are often complicated by systemic hypotension, despite aggressive fluid resuscitation and an increased cardiac output. If the physician wishes to restore arterial pressure (>80-85 mmHg), with the aim of sustaining organ perfusion pressure, the administration of systemic vasopressor agents, such as noradrenaline, becomes necessary. Because noradrenaline induces vasoconstriction in many vascular beds (visibly in the skin), however, it may decrease renal and visceral blood flow, impairing visceral organ function. This unproven fear has stopped clinicians from using noradrenaline more widely. In vasodilated states, unlike in normal circulatory conditions, however, noradrenaline may actually improve visceral organ blood flow. Animal studies show that the increased organ perfusion pressures achieved with noradrenaline improve the glomerular filtration rate and renal blood flow. There are no controlled human data to define the effects of noradrenaline on the kidney, but many patient series show a positive effect on glomerular filtration rate and urine output. There is no reason to fear the use of noradrenaline. If it is used to support a vasodilated circulation with a normal or increased cardiac output, it is likely to be the kidney's friend not its foe.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Kidney Injury / drug therapy
  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / physiopathology
  • Animals
  • Blood Pressure / drug effects
  • Decision Making
  • Dopamine / therapeutic use
  • Glomerular Filtration Rate / drug effects
  • Humans
  • Hypotension / drug therapy*
  • Hypotension / etiology*
  • Hypotension / physiopathology
  • Intensive Care Units
  • Multiple Trauma / complications
  • Multiple Trauma / physiopathology
  • Norepinephrine / adverse effects
  • Norepinephrine / therapeutic use*
  • Renal Circulation / drug effects*
  • Shock, Septic / complications
  • Shock, Septic / physiopathology
  • Vasoconstriction / drug effects*
  • Vasoconstrictor Agents / adverse effects
  • Vasoconstrictor Agents / therapeutic use*
  • Vasodilation


  • Vasoconstrictor Agents
  • Dopamine
  • Norepinephrine