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PubMed1982

Effects of different diuretics on tetracycline-induced hyperuraemia and hypercreatininaemia in the rat.

Tetracycline injection (45 mg/kg, i.v.) produced increases in plasma urea and creatinine levels in rats. The greatest increases occurred after 24 hr for urea and after 6 hr for creatinine, the latter effect persisted for at least 30 hr. The actions of six diuretics (acetazolamide, bumetanide, chlorothiazide, chlorthalidone, triamterene and indapamide) given orally either as pretreatment (1 hr before tetracycline injection) or post-treatment (4 hr after tetracycline injection) were examined. When given as pretreatments, all six diuretics reduced the hyperuraemia, and generally the hypercreatininaemia, that existed 24 hr after tetracycline injection. In contrast, when given as post-treatments, only bumetanide reduced the increase in urea and creatinine levels. It is postulated that this protective action of diuretics could occur by their displacement of tetracycline molecules from protein binding sites or by a-direct action on renal function.

Animals↗
PubMed1981

Gentamicin-induced nephrotoxicity in mice: protection by loop diuretics.

Gentamicin, at doses of 50 or 100 mg/kg body wt administered daily to healthy male MF1 mice by i.p. injection for either 7 or 10 days caused proximal tubular cell damage shown both by the urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) and by electron microscopy. The tubular damage was maximal at 7 days. Concomitant administration of any of 3 diuretics-frusemide, bumetanide or piretanide at 5,0.5 and 1 mg/kg body wt/day respectively-resulted in less tubular damage than that caused by gentamicin alone. This finding of protection by diuretics contrasts with those of previous studies of combination gentamicin-diuretic therapy.

Acetylglucosaminidase↗
PubMed1981

Symptomatic hypokalemia resulting from surreptitious diuretic ingestion.

We report five cases of symptomatic hypokalemia caused by surreptitious diuretic ingestion. A positive diagnosis was made in four patients by a colorimetric detection of the diuretic in urine by simple chemical means. Patients who surreptitiously ingest diuretics appear to be mainly women, among whom there appears to be high prevalence of diagnoses involving the reproductive system. Many of these patients have health-related occupations. They seem to be very concerned with appearing obese or edematous. A high urine potassium level in the presence of a low serum potassium level can suggest this diagnosis.

Adult↗
PubMed1995

[The role of diuretics in antihypertensive therapy].

Hypertensive therapy based on diuretics is time-honored. Thiazides represent the most commonly used class of diuretics for uncomplicated hypertension because of economic motivations, their tolerance and efficacy both as monotherapy and in combined treatment with other agents. Clinical studies using diuretics and beta-blockers reported that thiazide treatment prevents the development of malignant hypertension, renal and heart failure, hypertensive retinopathy, and reduces in five years overall mortality of 33%, cardiovascular mortality of 41%, fatal and non-fatal cerebrovascular events of 51% and the risk of coronary events of 15%. The less than expected risk reduction of cardiovascular disease raised many concerns about the possibility of adverse biochemical changes of thiazides through their effects on lipids, electrolytes and glucose metabolism. However, the real clinical significance of these metabolic effects remains actually uncertain and needs further investigation. The treatment of the hypertensive patient cannot be adequately managed using a merely adjunctive step-care criterium. Hypertensive subjects have different haemodynamic, metabolic and endocrine disorders and a tailored treatment should consider the different activities of the various agents as monotherapy or in association in the single patient.

Antihypertensive Agents↗
PubMed1994

Loop diuretics and renal vasodilators in acute renal failure.

Loop diuretics are powerful drugs able to increase urinary sodium and water excretion even in conditions of marked impairment of renal function. Loop diuretics are useful in preventing or ameliorating the course of acute renal failure. This effect may be obtained when they are used within 18 h after the ischaemic and/or toxic event. Loop diuretics reduce tubular work, providing resistance to cellular ischaemia. Other important beneficial effects include tubular wash-out of cellular debris and inhibition of tubuloglomerular feedback. Among vasodilators, dopamine, when used at 'dopaminergic dosage' is useful in preventing acute renal failure. Its efficacy is demonstrated in several situations of renal hypoperfusion, i.e. salt depletion, cyclosporin administration, and therapy with recombinant interleukin 2 in cancer patients. According to our studies it appears that dopamine should be used in the early phases of acute renal failure to improve renal perfusion, re-establish glomerular filtration rate, and increase tubular flow.

Acute Kidney Injury↗
PubMed1976

[Bumetanide, a new diuretic active during chronic renal failure (author's transl)].

Bumetanide is a new diuretic, which acts in the ascending limb of Henle's loop. The use of very high doses (5 to 40 mg/24 h) in 32 patients with advanced chronic renal insufficiency gave a clear diuretic effect in half the patients with a creatinine clearance of less than 3 ml/min and in 2/3 of the cases with a creatinine clearance between 3 and 10 ml/min. The efficacy of high doses of bumetanide, as well as their good tolerance shows an action of this new diuretic similar to that of furosemide.

Adult↗
PubMed1975

[Fluid redistribution between the extracellular medium and the cells in the diuretic therapy of cardiac insufficiency].

The antipyrine and thiosulphate spaces were measured in patients with circulatory insufficiency of the II B and III stages before and after medication with cardiac glycosides and diuretics, used in various combinations and in courses of different duration and also in 2-week long courses of treatment with ethacrine acid and aldactone in order to study the nature of changes in the water-electrolyte exchange in cardiac insufficiency following diminution of edemas occurring under the effect of an effective therapy. The main indication of cardiac insufficiency, the expansion of the extracellular space, was found to continue even after a clinically effective treatment and complete disappearance of edemas. When myocardial contractility continues to be at a low level and the aldosterone activity is high--the removal from the organism of a large quantity of fluid with the help of diuretics, while reducing the external clinical manifestations of the edematous conditions, aggravates at the same time the pathological nature of the fluid distribution between the extracellular medium and the cells, this being due, in the main, to the reduction in the amount of fluid in the cells. The differences between ethacrine acid and aldactone find their expression not only in a greater of smaller effectiveness of their diuretic action, but also in the influence which they exert on the regulation of water metabolism in cardiac insufficiency.

Adult↗
PubMed1993

[Diuretics in the treatment of hypertension].

Diuretics are one of the basic groups of antihypertensive drugs. They have also certain limitations and undesirable effects which are better defined than in other more recently developed antihypertensives. Undesirable effects can be prevented by early combination of saluretics with K+ sparing diuretics or other antihypertensive drugs and by prevention of metabolic disorders (in particular insulin resistance and dyslipoproteinaemia) and by prescription of small doses. Only prospective intervention studies will show whether the advantages of other groups of antihypertensives, as compared with diuretics, will influence the prognosis of patients with essential hypertension in a substantial way. Several studies along these lines are under way.

Antihypertensive Agents↗
PubMed1993

[Resistance to diuretic therapy].

Sequential nephron blockade--the combination of several diuretic agents which inhibit sodium reabsorption at different nephron sites simultaneously--is an effective, but potentially dangerous means of treating resistant edema. Several drug combinations have been used successfully, especially they have included a loop diuretic (furosemide in most cases) and the distal tubule-acting diuretics (hydrochlorothiazide).

Diuretics↗
PubMed1977

Comparative diuretic activity of delta9-tetrahydrocannabinol, cannabidiol, cannabinol and hydrochlorothiazide in the rat.

Orally administered delta9-tetrahydrocannabinol (THC) produced a dose-dependent increase in urine output in hydrated rats similar in mg/kg potency and magnitude of effect to hydrochlorothiazide (HCT). Whereas HCT promoted marked excretion of Na+, K+ and Cl- and an increase in the urinary Na+/K+ at all diuretic doses (1.25-20.0 mg/kg), THC had only a slight effect on Na+ and K+ excretion but not Cl- even after the highest dose tested (20.0 mg/kg). Hypophysectomy and adrenalectomy abolished the diuretic effect of THC, thus suggesting both central and peripheral sites of action for the diuretic effect of THC. Tolerance to the effect on urine output by THC developed after 15 days of repeated dosing, while urine output and electrolyte excretion remained significantly elevated after 25 days of HCT administration.

Administration, Oral↗
PubMed1996

[Wobenzyme and diuretic therapy in lymphedema after breast operation].

The authors of this clinical study report the results of a controlled clinical trial in randomized parallel groups (Wobenzym vs. diuretics) of 55 female patients suffering from brachial arm lymph edema subsequent to ablatio mammae. All patients received manual and machine lymph drainage as well as gymnastics as concomitant therapy. After 7 weeks of therapy the results of the volometric assessments of the arm, the circumference of the arm and the skinfold thickness showed significant improvements compared to diuretics. In addition, the patients receiving Wobenzym reported a significantly higher proportion of patients free of pain compared to the diuretics patients. Overall safety assessment results are satisfactory thus resulting in a superior benefit/risk relation of the Wobenzym group.

Adjuvants, Immunologic↗
PubMed1996

[Treatment of cardiac failure with angiotensin-converting enzyme inhibitors and diuretics].

Congestive cardiac failure is characterised by redistribution of blood flow to the brain and the heart at the expense of the kidneys. The prognosis of this condition at its most advanced stage (stage IV) is poor with a mortality of about 50% at 5 years. The reduction of renal perfusion will lead to stimulation of all vasoconstrictor and anti-natiuretic mechanisms, and to a parallel activation of vasodilator and natiuretic systems. There is, therefore, a clear conflict of interest between the heart, which attempts to preserve its perfusion and function, and the kidneys which aggravate the haemodynamic disturbances by salt and water overload and the risk of arrhythmias due to hypokalaemia and hypomagnesaemia. The diuretics and ACE inhibitors are essential therapeutic classes for the treatment of congestive cardiac failure. The prevention of the secondary effects of diuretics and ACE inhibitors on renal function, serum sodium, potassium and magnesium concentrations, is based on an initial low dose prescription, the detection and correction of risk factors and strict clinical and biological surveillance. In order to avoid the risks of hyperkalaemia during the association of ACE inhibitor and diuretic therapy with a potassium sparing agent, the initial dose of these two drugs should be as low as possible.

Aged↗
PubMedDate not supplied

[Diuretics in the treatment of hypertension: critical analysis of opinions of general practitioners and cardiologists].

To better evaluate the clinical practice of French practitioners regarding the treatment of hypertension and the use of diuretics, we conducted a study using quota method to select 240 general practitioners and 90 cardiologists. Diuretics are still widely used and are effective well known drugs. Their use is nevertheless restricted by some side effects such as increasing frequency of micturition and electrolyte disturbances. These side effects are reduced with the new lower dosages and slow release formulations. Analysis of the results of our study suggests that the use of diuretics depends more on old habits and industry communication on drugs than on the knowledge of the results of therapeutic trials on mortality and morbidity.

Cardiology↗
PubMed1977

[Change in rheographic properties of blood in congestive circulatory insufficiency treated with diuretics].

Proceeding from a dynamic study of the rheological properties of blood in 85 patients with stage II-III congestive circulatory insufficiency treated with diuretics (Furosemid, Hypothiazid, Uregit, Verospiron) a conclusion is made that a rational employment of diuretic agents does not result in any increase in blood concentration, and does not increase the risk of thrombotic complications. On the contrary, in some patients with stage IIB-III circulatory insufficiency some normalization of the rheological properties of blood, that had been impaired before the treatment, was noted. The use of diuretics only moderately increased the hematocrit and blood viscosity values, but decreased the aggregation of the erythrocytes and platelets. The improvement of the rheological properties of blood was attributed to the normalization of the water-electrolyte disorders that the patients had had. In cases in which thrombotic complications occurred a low hematocrit and blood viscosity level was common, while the erythrocytes and platelets aggregation was increased.

Adult↗
PubMed1996

[Usefulness of 99mTc-DTPA renography and diuretic renography in predicting successful stone discharge following outpatient ESWL in patients with a single ureteral stone].

We analyzed the 99mTc-DTPA renogram with and without diuresis to predict the possibility of stone discharge on the outpatient basis by renogram patterns. Between October, 1993 and December, 1995, 99mTc-DTPA renography was performed in 79 patients with a single ureteral stone. The 99mTc-DTPA renogram pattern was classified into the three types of normal function, obstruction and lower function patterns and the complete stone discharge rate was 93, 63 and 25%, respectively. In addition, diuretic renography using Furosemide was performed in patients with an obstruction pattern and the three renogram patterns of return to the normal curve, a diuretic response and no response were obtained; the complete stone discharge rate was 44, 65.3 and 93%, respectively. From this study, patients with a single ureteral stone with a normal pattern on the regular DTPA renogram and patients with no response pattern on the diuretic renogram, even if in such patients an obstructive pattern was seen on the regular DTPA renogram, seem to be a good candidate for obtaining a high rate of a stone discharge with extracorporeal shock wave lithotripsy (ESWL) treatment in the outpatients basis.

Diuretics↗
PubMed1996

[Surreptitious intake of diuretics as the cause of pseudo-Bartter's syndrome: apropos of a case and differential diagnosis].

We describe a 39 years old patient with a history of chronic symptomatic hypokalemia. She denied taking any drugs. She satisfied the clinical criteria for Bartter's syndrome and more precisely for Gitelman's syndrome: hypokalemia in the presence of inappropriately high potassium excretion, metabolic alkalosis, hyperreninemic hyperaldosteronism, hypomagnesemia with inappropriately high magnesium excretion, normocalcemia, hypocalciuria and normal blood pressure. A HPLC analysis detected the presence of furosemide in urine and chlorthalidone in urine and plasma samples. After the self administration of diuretics was stopped, the above alterations came back to normality. Prior to the verification of a self administration of diuretics, the patient showed clinical and biochemical parameters that oriented to surreptitious diuretic ingestion (Pseudo-Bartter's syndrome) not to Bartter's syndrome or Gitelman's syndrome, particularly the plasma potassium readily restored to normal by the administration of potassium chloride supplements, the increased plasma uric acid with low uric acid fractional clearance, the widely different urine and plasma electrolyte levels and the presence psychiatric disorders. The literature is reviewed and differential diagnosis, among this three syndromes, is made.

Adult↗
PubMed1996

Fused pyrimidines. Synthesis of new derivatives of potential diuretic activity.

Certain derivatives of quinazoline and its bioisostere pyridopyrimidine carrying important structural features that contribute to diuretic activity, such as sulfonamido, morpholino and chlorophenyl, were prepared as potential diuretic agents. Likewise, some tricyclic 1,2,4-triazolo[3,4-b]quinazolines and pyrido[3,2-d][1,2,4]triazolo[4,3-alpha] pyrimidines with the same features were reported. Nine compounds were tested for the diuretic activity in rats and the results showed that the active compound is 7-chloro-2-methyl-3-phthalimido-4(3H)-quinazoline (4).

Animals↗
PubMed1997

Physiologic role and diuretic efficacy of atrial natriuretic peptide in health and chronic renal disease.

In recent years, different clinical studies have provided new information on the pathophysiological role and diuretic effectiveness of atrial natriuretic peptide (ANP) in subjects with normal renal function and patients with chronic renal disease. Plasma ANP (pANP) was increased by infusion at the lowest doses ever tested in humans who were on low salt diet to the levels that the same subjects gained when on a normal salt diet; ANP accounted for at least 40% of the increase of natriuresis. Similarly, ANP appeared to be mainly involved in the physiological down-regulation of salt excretion (that is, during the shift from a normal to low-sodium diet). Interestingly, data have been also attained on the efficacy of ANP as diuretic agent when administered at a low nonhypotensive dosage in normals as well as CRF patients. Indeed, low-dose ANP promoted a marked increase of sodium excretion in CRF patients to the same levels observed in normals, likely because the renal patients exhibited a more marked pANP increment secondary to the lower renal catabolism of the infused hormone. Moreover, aldosterone suppression was greater in CRF patients with respect to normals. Furthermore, the fractional urinary excretion of cGMP increased more in CRF patients than in normals. Finally, ANP infusion augmented the urinary losses of the main solutes retained in CRF (urea, potassium, phosphorous) with a significant decrease in the plasma levels. Hence, ANP per se not only plays a significant role in the up- and down-regulation of sodium excretion in healthy state and chronic renal disease, but it may also be considered to be a powerful and unique diuretic agent in CRF at nonhypotensive dosages.

Animals↗