title: Diuretic agents. Mechanisms of action and clinical uses.
abstract: Diuretics act primarily by blocking reabsorption of sodium at four major sites in the nephron. Clinically useful agents that block sodium reabsorption effectively in the proximal tubule are lacking. Furosemide (Lasix), ethacrynic acid (Edecrin), and possibly organomercurial agents are effective in the ascending limb of Henle's loop. Thiazides are the major agents acting in the early distal tubule. In the late distal tubule and collecting duct, spironolactone (Aldactone) and triamterene (Dyrenium) are useful, especially in combination with diuretics which act more proximally. In treating edematous states, initial therapy with thiazides is effective in most patients who do not exhibit moderate or severe renal insufficiency, severe hyperaldosteronism with excessive distal reabsorption of sodium in exchange for potassium, or excessive sodium reabsorption in the proximal tubule or ascending limb. Nonedematous states in which diuretic therapy is useful include hypertension, hypercalcemia, hypercalciuria, diabetes insipidus, and acute renal failure.
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy; D001581:Benzothiadiazines; D002257:Carbonic Anhydrase Inhibitors / Q000494:pharmacology; D003919:Diabetes Insipidus / Q000188:drug therapy; D004232:Diuretics / Q000494:pharmacology* / Q000627:therapeutic use; D004234:Diuretics, Osmotic / Q000494:pharmacology; D004487:Edema / Q000188:drug therapy; D004976:Ethacrynic Acid / Q000494:pharmacology; D005665:Furosemide / Q000494:pharmacology; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D007668:Kidney / Q000378:metabolism*; D007686:Kidney Tubules, Distal / Q000378:metabolism; D007687:Kidney Tubules, Proximal / Q000378:metabolism; D008138:Loop of Henle / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009399:Nephrons / Q000378:metabolism*; D009941:Organomercury Compounds / Q000494:pharmacology; D012964:Sodium / Q000378:metabolism; D049993:Sodium Chloride Symporter Inhibitors / Q000494:pharmacology; D013148:Spironolactone / Q000494:pharmacology; D014223:Triamterene / Q000494:pharmacology; D014970:Xanthines / Q000494:pharmacology
chemical_list: D001581:Benzothiadiazines; D002257:Carbonic Anhydrase Inhibitors; D004232:Diuretics; D004234:Diuretics, Osmotic; D009941:Organomercury Compounds; D049993:Sodium Chloride Symporter Inhibitors; D014970:Xanthines; D013148:Spironolactone; D005665:Furosemide; D012964:Sodium; D004976:Ethacrynic Acid; D014223:Triamterene