[Renal function, organic acid transport and protein binding: the three elements defining the response to diuretics in clinical practice: an update].
Organic anion transporters (OATs), which are expressed in proximal tubule cells, mediate diuretic secretion into tubular fluid. Increased plasma levels of organic anions and urate and metabolic acidosis, i.e. two characteristic features of chronic renal insufficiency, could be factors contributing to diuretic resistance. These limitations demand increasing doses of diuretics up to a maximum level, or the use of a loop diuretic with non-renal metabolism. Diuretic responsiveness in nephrotic syndrome is limited by strong Na+ reabsorption in the distal nephron. Strategies to improve loop diuretic responsiveness include diuretic dosage and the combination of a loop diuretic with a distal acting diuretic. Strategies to limit protein excretion include the use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers and appropriate salt intake limitation.
Conz
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Divisione di Nefrologia e Dialisi, Ospedale Vittorio Emanuele III, 35043 Monselice (PD), Italy. Piero.Conz@ulss17.it
D004232:Diuretics / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D007668:Kidney / Q000378:metabolism* / Q000503:physiopathology; D007674:Kidney Diseases / Q000378:metabolism* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000378:metabolism; D009399:Nephrons / Q000378:metabolism; D009404:Nephrotic Syndrome / Q000378:metabolism; D011485:Protein Binding
D004232:Diuretics