The market in human urine

In the 1970s, physicians started to use diuretics in patients who appeared to be sliding into acute renal failure.  This was based on reports that nonoliguric renal failure carried a lower mortality rate (around 25%) than did the more traditional oliguric renal failure (with about a 50% mortality rate.  It appeared that, on occasion, patients could be converted from oliguric to nonoliguric renal failure by using a diuretic, such as furosemide (Lasix).

However, when real science was applied to this concept in the form of prospective randomized trials, it turns out that, despite an increased urine output with the use of diuretics, the desired improvement in mortality did not happen:

• Cantarovich, 1971
• Cantarovich, 1973
• Chandra, 1975
• Kleinknecht, 1976
• Lucas, 1977
• Brown, 1981
• Shilliday, 1997
• Sirivella, 2000
• Cantarovich, 2004
• Bagshaw, 2007

To summarize the findings from these studies, it appears that diuretic administration to patients with impending renal failure does not alter their outcome compared to patients who do not receive diuretics: there is no difference in length of stay, need for dialysis, or mortality.  However, there is an increased urine output in those patients who were in the diuretic study group.

Thus, the primary outcome of such therapy is the production of more human urine.  This outcome would be beneficial if there were some kind of market for human urine than needed to be satisfied.  But, of course, no such market exists, so it begs the question of why are we doing this. 

Despite the overwhelming evidence that it would make sense to stop the practice of administering diuretics to patients with impending renal failure, it would actually be a paradigm shift in medicine to do so.