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Diuretic resistance is defined as failure of diuretics to reduce fluid retention (can be measured by low urinary sodium) despite using the maximal dose of drugs. There are various causes for the resistance towards loop diuretics.
Metolazone may be combined with other diuretics (typically loop diuretics) to treat diuretic resistance in congestive heart failure, chronic kidney disease, and nephrotic syndrome. [3] Metolazone and a loop diuretic will synergistically enhance diuresis over the use of either agent alone.
Spironolactone is used as add-on therapy to ACEI plus loop diuretic in severe CHF. Eplerenone is specifically indicated for post-MI reduction of cardiovascular risk. If a heart failure patient exhibits a resistance to or poor response to diuretic therapy, ultrafiltration or aquapheresis may be needed to achieve adequate control of fluid ...
The antihypertensive actions of some diuretics (thiazides and loop diuretics in particular) are independent of their diuretic effect. [ 1 ] [ 2 ] That is, the reduction in blood pressure is not due to decreased blood volume resulting from increased urine production , but occurs through other mechanisms and at lower doses than that required to ...
A picture showing the sites of action of diuretics in the renal tubule. Diuretics act primarily by reducing the reabsorption of sodium at different sites of the renal tubular system and consequently promoting the elimination of sodium and water with increased urine output. [3] Loop diuretics: furosemide, bumetanide, torsemide, ethacrynic acid
Furosemide blocks NaCl reabsorption mediated by the NKCC2 at the ascending loop of henle, which leads to increased renin release. Excluding loop diuretic use, the usual situation that causes a reduction in reabsorption of NaCl via the NKCC2 at the macula densa (DCT) is a low tubular lumen concentration of NaCl due to low GFR.
Lithium-induced nephrogenic DI may be effectively managed with the administration of amiloride, a potassium-sparing diuretic often used in conjunction with thiazide or loop diuretics. Clinicians have been aware of lithium toxicity for many years, and traditionally have administered thiazide diuretics for lithium-induced polyuria and nephrogenic ...
The tendency, as for all loop diuretics, to cause low serum potassium concentration (hypokalemia) has given rise to combination products, either with potassium or with the potassium-sparing diuretic amiloride (Co-amilofruse). Other electrolyte abnormalities that can result from furosemide use include hyponatremia, hypochloremia, hypomagnesemia ...