title: Diuretics in acute kidney injury.
abstract: Acute kidney injury (AKI) is common in hospitalized patients and is associated with significant morbidity and mortality. The incidence of AKI is increasing and despite clinical advances there has been little change in the outcomes associated with AKI. A variety of interventions, including loop diuretics, have been tested for the prevention and treatment of AKI; however, none to date have shown convincing benefits in clinical studies, and the management of AKI remains largely supportive. In this article, we review the pharmacology and experimental and clinical evidence for loop diuretics in the management of AKI. In addition, we also review evidence for other agents with diuretic and/or natriuretic properties such as thiazide diuretics, mannitol, fenoldopam, and natriuretic peptides in both the prevention and treatment of AKI. Implications for current clinical practice are outlined to guide clinical decisions in this field.
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Boston, MA 02114, USA. sagarnigs@gmail.com
authors.forename: Sagar U
authors.initials: SU
authors.lastname: Nigwekar
authors.forename: Sushrut S
authors.initials: SS
authors.lastname: Waikar
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy*; D004232:Diuretics / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D004234:Diuretics, Osmotic / Q000494:pharmacology / Q000627:therapeutic use; D018818:Fenoldopam / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D045265:Natriuretic Peptides / Q000494:pharmacology / Q000627:therapeutic use; D049993:Sodium Chloride Symporter Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D004232:Diuretics; D004234:Diuretics, Osmotic; D045265:Natriuretic Peptides; D049993:Sodium Chloride Symporter Inhibitors; D049994:Sodium Potassium Chloride Symporter Inhibitors; D018818:Fenoldopam