Diuretic: Difference between revisions

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==Medical uses==
==Medical uses==
Diuretics may be used to treat [[hypertension]], [[heart failure]], and other illnesses.<ref name="pmid9691107">{{cite journal |author=Brater DC |title=Diuretic therapy |journal=N. Engl. J. Med. |volume=339 |issue=6 |pages=387–95 |year=1998 |month=August |pmid=9691107 |doi= |url=http://content.nejm.org/cgi/content/full/339/6/387 |issn=}}</ref> Occassionally high doses or combinations of diuretics are needed.<ref name="pmid9691107"/><ref name="pmid7046434">{{cite journal |author=Wollam GL, Tarazi RC, Bravo EL, Dustan HP |title=Diuretic potency of combined hydrochlorothiazide and furosemide therapy in patients with azotemia |journal=Am. J. Med. |volume=72 |issue=6 |pages=929–38 |year=1982 |month=June |pmid=7046434 |doi= |url= |issn=}}</ref><ref name="pmid7967362">{{cite journal |author=Fliser D, Schröter M, Neubeck M, Ritz E |title=Coadministration of thiazides increases the efficacy of loop diuretics even in patients with advanced renal failure |journal=Kidney Int. |volume=46 |issue=2 |pages=482–8 |year=1994 |month=August |pmid=7967362 |doi= |url= |issn=}}</ref><ref name="pmid8583780">{{cite journal |author=Knauf H, Mutschler E |title=Diuretic effectiveness of hydrochlorothiazide and furosemide alone and in combination in chronic renal failure |journal=J. Cardiovasc. Pharmacol. |volume=26 |issue=3 |pages=394–400 |year=1995 |month=September |pmid=8583780 |doi= |url= |issn=}}</ref>
Diuretics may be used to treat [[hypertension]], [[heart failure]], and other illnesses.<ref name="pmid9691107">{{cite journal |author=Brater DC |title=Diuretic therapy |journal=N. Engl. J. Med. |volume=339 |issue=6 |pages=387–95 |year=1998 |month=August |pmid=9691107 |doi= |url=http://content.nejm.org/cgi/content/full/339/6/387 |issn=}}</ref> Occasionally high doses or combinations of diuretics are needed.<ref name="pmid9691107"/><ref name="pmid7046434">{{cite journal |author=Wollam GL, Tarazi RC, Bravo EL, Dustan HP |title=Diuretic potency of combined hydrochlorothiazide and furosemide therapy in patients with azotemia |journal=Am. J. Med. |volume=72 |issue=6 |pages=929–38 |year=1982 |month=June |pmid=7046434 |doi= |url= |issn=}}</ref><ref name="pmid7967362">{{cite journal |author=Fliser D, Schröter M, Neubeck M, Ritz E |title=Coadministration of thiazides increases the efficacy of loop diuretics even in patients with advanced renal failure |journal=Kidney Int. |volume=46 |issue=2 |pages=482–8 |year=1994 |month=August |pmid=7967362 |doi= |url= |issn=}}</ref><ref name="pmid8583780">{{cite journal |author=Knauf H, Mutschler E |title=Diuretic effectiveness of hydrochlorothiazide and furosemide alone and in combination in chronic renal failure |journal=J. Cardiovasc. Pharmacol. |volume=26 |issue=3 |pages=394–400 |year=1995 |month=September |pmid=8583780 |doi= |url= |issn=}}</ref>
 
==Adverse effects==
[[Hydrochlorothiazide]] at doses above 25 mg per day may be associated with sudden cardiac death.<ref name="pmid8196728">{{cite journal |author=Siscovick DS, Raghunathan TE, Psaty BM, ''et al'' |title=Diuretic therapy for hypertension and the risk of primary cardiac arrest |journal=N. Engl. J. Med. |volume=330 |issue=26 |pages=1852–7 |year=1994 |month=June |pmid=8196728 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=8196728&promo=ONFLNS19 |issn=}}</ref>


==References==
==References==
<references/>
<references/>

Revision as of 23:04, 19 September 2008

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Diuretics are "agents that promote the excretion of urine through their effects on kidney function."[1]

Physiology of sodium reabsorption in the kidney

Physiology of sodium reabsorption in the kidney
Location in nephron Proportion of total sodium reabsorption
accounted for		 Membrane transport protein
Ion pump or ion channel		 Diuretics that
act at this location
Proximal convulated tubule 40% Carbonic anhydrase
Sodium-hydrogen antiporter (Ion pump)		 Carbonic anhydrase inhibitors
Late proximal tubule   Chloride-bicarbonate antiporter (Ion pump)  
Loop of Henle:
thin descending limb		 0% Not applicable Osmotic diuretics
Loop of Henle:
thick ascending limb
('diluting segment')		 25% Sodium potassium chloride symporter (Ion pump) Loop diuretics
Distal convulated tubule 10% Sodium chloride symporter (Ion pump) Thiazides
Collecting tubule 2-5% Mineralacorticoids receptors
Sodium channel (Ion channel)		 Potassium-sparing diuretics

Classification

Carbonic anhydrase inhibitors

Carbonic anhydrase inhibitors are a "class of compounds that reduces the secretion of h+ ions by the proximal kidney tubule through inhibition of carbonic anhydrases."[2][3]

Osmotic diuretic

Osmotic diuretics are "compounds that increase urine volume by increasing the amount of osmotically active solute in the urine. Osmotic diuretics also increase the osmolarity of plasma."[4]

Loop diuretics

More formally called sodium potassium chloride symporter inhibitors, these are agents that inhibit sodium-potassium-chloride symporters in the thick ascending limb at the junction of the Loop of Henle and distal kidney tubules.[5]

Thiazides

Thiazides are "heterocyclic compounds with sulfur and nitrogen in the ring. This term commonly refers to the benzothiadiazines that inhibit sodium-potassium-chloride symporters."[6]

Potassium-sparing diuretics

These work in the collecting duct and late distal convoluted tubule either by inhibiting mineralacorticoids receptors or by blocking sodium channels.[7][8]

Vasopressin antagonists

Tolvaptan, a vasopressin antagonist, may be beneficial according to a randomized controlled trial.[9][10] Tolvaptan is a selective cell surface receptors V2 antagonist in the distal nephron which causes loss of free water.[11] Other vasopressin antagonists act mainly on V1a cell surface receptors.

Brain (B-type) natriuretic peptide

Nesiritide, a brain (B-type) natriuretic peptide, may help patients with decompensated congestive heart failure according to a randomized controlled trial.[12] Natriuretic peptide causes diuresis, vasodilitation, and suppression of the renin-angiotensin system and sympathetic nervous system.[12]

Medical uses

Diuretics may be used to treat hypertension, heart failure, and other illnesses.[13] Occasionally high doses or combinations of diuretics are needed.[13][14][15][16]

Adverse effects

Hydrochlorothiazide at doses above 25 mg per day may be associated with sudden cardiac death.[17]

References

  1. ↑ Anonymous (2024), Diuretic (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Anonymous (2024), Carbonic anhydrase inhibitors (English). Medical Subject Headings. U.S. National Library of Medicine.
  3. ↑ Katzung, Bertram G. (2001). “Diuretic Agents”, Basic & Clinical Pharmacology. New York: Lange Medical Books/McGraw-Hill, 249. ISBN 0-8385-0598-8. 
  4. ↑ Anonymous (2024), Osmotic diuretics (English). Medical Subject Headings. U.S. National Library of Medicine.
  5. ↑ Anonymous (2024), Sodium Potassium Chloride Symporter Inhibitors (English). Medical Subject Headings. U.S. National Library of Medicine.
  6. ↑ Anonymous (2024), Thiazides (English). Medical Subject Headings. U.S. National Library of Medicine.
  7. ↑ Anonymous (2024), Sodium channel blockers (English). Medical Subject Headings. U.S. National Library of Medicine.
  8. ↑ Katzung, Bertram G. (2001). “Diuretic Agents”, Basic & Clinical Pharmacology. New York: Lange Medical Books/McGraw-Hill, 256. ISBN 0-8385-0598-8. 
  9. ↑ Gheorghiade M et al. Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST Clinical Status Trials. JAMA 2007;297:1332-43. Epub 2007 Mar 25. PMID 17384438
  10. ↑ Konstam MA et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA 2007;297:1319-31. Epub 2007 Mar 25. PMID 17384437
  11. ↑ Goldsmith SR, Gheorghiade M. Vasopressin antagonism in heart failure. J Am Coll Cardiol. 2005;46:1785-91. PMID 16286160
  12. ↑ 12.0 12.1 Colucci WS, et al. Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. Nesiritide Study Group. N Engl J Med. 2000 Jul 27;343(4):246-53. Erratum in: N Engl J Med 2000 Nov 16;343(20):1504. N Engl J Med 2000;343:896. PMID 10911006
  13. ↑ 13.0 13.1 Brater DC (August 1998). "Diuretic therapy". N. Engl. J. Med. 339 (6): 387–95. PMID 9691107. [e]
  14. ↑ Wollam GL, Tarazi RC, Bravo EL, Dustan HP (June 1982). "Diuretic potency of combined hydrochlorothiazide and furosemide therapy in patients with azotemia". Am. J. Med. 72 (6): 929–38. PMID 7046434. [e]
  15. ↑ Fliser D, Schröter M, Neubeck M, Ritz E (August 1994). "Coadministration of thiazides increases the efficacy of loop diuretics even in patients with advanced renal failure". Kidney Int. 46 (2): 482–8. PMID 7967362. [e]
  16. ↑ Knauf H, Mutschler E (September 1995). "Diuretic effectiveness of hydrochlorothiazide and furosemide alone and in combination in chronic renal failure". J. Cardiovasc. Pharmacol. 26 (3): 394–400. PMID 8583780. [e]
  17. ↑ Siscovick DS, Raghunathan TE, Psaty BM, et al (June 1994). "Diuretic therapy for hypertension and the risk of primary cardiac arrest". N. Engl. J. Med. 330 (26): 1852–7. PMID 8196728. [e]
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