[Diuretics in renal failure]. 1996

E Ritz
Medizinischen Universitätsklinik Heidelberg, Deutschland.

The indications for the use of diuretics in patients with renal failure are edema and hypertension. An ancillary measure is dietary sodium restriction which permits reduction of the diuretic dose and reduces the frequency of diuretic induced side effects. The natriuretic action of diuretics is attenuated in renal failure both for pharmacokinetic and pharmacodynamic reasons. The most important cause for reduced efficacy of diuretics in renal patients is binding of diuretics to proteins within the tubular lumen so that the absolute free concentration of diuretics is diminished. Further important reasons for the diminished increment in urinary sodium excretion that is seen in patients with renal failure include a) reduced number of nephrons (i.e. reduced functional mass) and b) intrarenal compensatory mechanisms which increase sodium activity and tubular reabsorption of sodium. These difficulties can be overcome by dietary sodium restriction, by selection of higher doses of diuretics, by selection of appropriate intervals of administration and by combination of loop diuretics and thiasides. In order to recognize side effects resulting from excessive diuresis with hypovolemia and increase of serum creatinine concentration from prerenal causes it is necessary to closely monitor the patients.

UI MeSH Term Description Entries
D006977 Hypertension, Renal Persistent high BLOOD PRESSURE due to KIDNEY DISEASES, such as those involving the renal parenchyma, the renal vasculature, or tumors that secrete RENIN. Hypertensions, Renal,Renal Hypertension,Renal Hypertensions
D007676 Kidney Failure, Chronic The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION. ESRD,End-Stage Renal Disease,Renal Disease, End-Stage,Renal Failure, Chronic,Renal Failure, End-Stage,Chronic Kidney Failure,End-Stage Kidney Disease,Chronic Renal Failure,Disease, End-Stage Kidney,Disease, End-Stage Renal,End Stage Kidney Disease,End Stage Renal Disease,End-Stage Renal Failure,Kidney Disease, End-Stage,Renal Disease, End Stage,Renal Failure, End Stage
D007677 Kidney Function Tests Laboratory tests used to evaluate how well the kidneys are working through examination of blood and urine. Function Test, Kidney,Function Tests, Kidney,Kidney Function Test,Test, Kidney Function,Tests, Kidney Function
D011485 Protein Binding The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific protein-binding measures are often used as assays in diagnostic assessments. Plasma Protein Binding Capacity,Binding, Protein
D003131 Combined Modality Therapy The treatment of a disease or condition by several different means simultaneously or sequentially. Chemoimmunotherapy, RADIOIMMUNOTHERAPY, chemoradiotherapy, cryochemotherapy, and SALVAGE THERAPY are seen most frequently, but their combinations with each other and surgery are also used. Multimodal Treatment,Therapy, Combined Modality,Combined Modality Therapies,Modality Therapies, Combined,Modality Therapy, Combined,Multimodal Treatments,Therapies, Combined Modality,Treatment, Multimodal,Treatments, Multimodal
D004039 Diet, Sodium-Restricted A diet which contains very little sodium chloride. It is prescribed by some for hypertension and for edematous states. (Dorland, 27th ed) Diet, Low-Salt,Diet, Low-Sodium,Diet, Salt-Free,Diet, Low Salt,Diet, Low Sodium,Diet, Salt Free,Diet, Sodium Restricted,Diets, Low-Salt,Diets, Low-Sodium,Diets, Salt-Free,Diets, Sodium-Restricted,Low-Salt Diet,Low-Salt Diets,Low-Sodium Diet,Low-Sodium Diets,Salt-Free Diet,Salt-Free Diets,Sodium-Restricted Diet,Sodium-Restricted Diets
D004232 Diuretics Agents that promote the excretion of urine through their effects on kidney function. Diuretic,Diuretic Effect,Diuretic Effects,Effect, Diuretic,Effects, Diuretic
D004305 Dose-Response Relationship, Drug The relationship between the dose of an administered drug and the response of the organism to the drug. Dose Response Relationship, Drug,Dose-Response Relationships, Drug,Drug Dose-Response Relationship,Drug Dose-Response Relationships,Relationship, Drug Dose-Response,Relationships, Drug Dose-Response
D004334 Drug Administration Schedule Time schedule for administration of a drug in order to achieve optimum effectiveness and convenience. Administration Schedule, Drug,Administration Schedules, Drug,Drug Administration Schedules,Schedule, Drug Administration,Schedules, Drug Administration
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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