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PubMed1984

[Effect of diuretics on the humoral system of kidney prostaglandins in hypertension patients].

Sixty-four patients with stage IIB essential hypertension were examined for the urinary excretion of prostaglandins E2 and F2 alpha, natriuresis and diuresis in the control period and then on the 3rd, and the 12th-14th day of the treatment with diuretics (furosemid, hypotiazid, oxodolin, brinaldix). All diuretics were found to alter the urinary PG excretion, with the degree of their effect depending on the type of the drug, the route and duration of its administration. Furosemid, to a greater degree than other diuretics, increased the urinary excretion of PGE2 thus bringing down the PGF2 alpha/PGE2 ratio, brinaldix increased PGF2 alpha excretion whereas hypotiazid, in cases of its prolonged employment, reduced the excretion of both PGs, the PGF2 alpha decrease being more prominent. PGE2 contributed to a decrease in BP and to the development of natriuresis. The physiological effect of PGF2 alpha depended on the status of the water-electrolyte balance in the body: in patients with IIB stage essential hypertension it facilitated the development of natriuresis and BP decrease. When following the administration of the diuretics the balance of sodium and water in the body lowered, PGF2 alpha caused the retention of sodium and water in the body and did not affect the BP.

Adult↗
PubMed1988

Acute diuretic effects in conscious rats produced by some medicinal plants used in the state of São Paulo, Brasil.

Extracts of 32 medicinal plants used popularly for their presumed diuretic and/or antihypertensive properties were tested for diuretic effects in conscious unrestrained rats. Extracts were made using aqueous ethanol (50:50, v/v) at 4-10 degrees C. When given orally at a dose of 40 ml/kg, a majority of the ethanol-free extracts produced a more pronounced diuresis than would be expected from the potassium concentration of the extracts. The most significant diuretic effect was observed with Hedychium coronarium sheath and leaf-blade extracts.

Animals↗
PubMed2001

Effects of albumin/furosemide mixtures on responses to furosemide in hypoalbuminemic patients.

Hypoalbuminemic patients often have sufficient fluid accumulation to mandate diuretic therapy but are often resistant to diuresis. Studies have suggested that hypoalbuminemia itself impairs delivery of effective amounts of diuretic agent into the urine, the site of action. Therefore, administration of mixtures of albumin and loop diuretics may enhance responses. Thirteen patients with biopsy-proven cirrhosis and ascites (age, 51.2 +/- 8.1 yr; Child-Pugh score, 8.5 +/- 1.0; serum albumin concentration, 3.0 +/- 0.6 g/dl) were studied in this randomized crossover study. Sodium balance was maintained throughout the study with a metabolic diet. All patients received spironolactone, but administration of all other diuretic agents was discontinued. Each patient received all of the following four treatments intravenously: (1) 40 mg of furosemide, (2) 25 g of albumin, (3) 40 mg of furosemide and 25 g of albumin premixed ex vivo, and (4) 40 mg of furosemide and 25 g of albumin infused simultaneously into different arms. Responses were assessed by measuring urinary sodium excretion and relating the urinary furosemide excretion rate to the sodium excretion rate. Additionally, the pharmacokinetics of furosemide were assessed. Furosemide pharmacokinetics were similar for all treatment arms. Albumin alone had negligible diuretic effects. Neither albumin regimen increased the response to furosemide. Moreover, the relationship between the urinary furosemide excretion rate and the sodium excretion rate was unaffected by albumin. In conclusion, albumin failed to enhance the diuretic effects of furosemide in cirrhotic patients with ascites. Therefore, the coadministration of albumin and furosemide for the treatment of cirrhosis, and likely other hypoalbuminemic conditions, should not be used clinically.

Adult↗
PubMed1997

Trypanosoma cruzi in the rectum of the bug Triatoma infestans: effects of blood ingestion of the vector and artificial diuresis.

The population density and the percentage of different developmental stages of an established infection of Trypanosoma cruzi were determined at 40 days after the last feeding of the fourth instar in the rectum (lumen, anterior and posterior wall) of fed and unfed groups of fifth instars of Triatoma infestans. Additionally, the rectum and the Malpighian tubules were incubated in saline, inducing diuresis by addition of the diuretic hormone. The rectum contained an average of 200,000-400,000 T. cruzi. After feeding the percentages of spheromastigotes and drop-like intermediate stages were reduced from < 7% and 15%, respectively, to < 3%, but those of slender intermediate stages increased statistically significantly from < 7% to 10%. After 4 h of diuresis the in-vitro-incubated isolated rectum with the four Malpighian tubules showed the same trends, indicating that diuresis rather than factors of the hemolymph or digestive products induces the development of metacyclic trypomastigotes of T. cruzi originating from epimastigotes.

Animals↗
PubMed1981

Diuretics.

Diuretics of current interest are classified according to their potency or site of action. The pharmacokinetics of furosemide, xipamide hydrochlorothiazide and triamterene are briefly described, and important adverse reactions and drug interactions involving diuretics are reviewed. The clinical indications for diuresis are presented.

Diuretics↗
PubMed1976

Heat tolerance following diuretic induced dehydration.

In an effort to assess the effects of acute fluid loss on body temperature regulation during exercise, seven subjects (one female and six males) were studied on two occasions during two hours of cycling (35% Vo2max) in a hot environment (39 degrees C = DB, 35% = RH). One trial (D) was conducted following a 3% body weight reduction, achieved with 40-80 mg oral administration of a diuretic "lasix." A control exercise bout was performed with the subject normally hydrated (H). As a result of the diuresis, plasma volume (PV) decreased 15.3% (SE +/- 1.3), while heart rates during exercise increased 20-25 beats/min when compared to the H condition. Although significantly greater increases (P less than 0.05) in rectal and muscle temperatures occurred during exercise in the D trial, mean skin temperature (TS) was lower. Skin blood flow estimated from conductance values averaged 800 ml/min less during the D condition than during exercise in the H trial. Since the preliminary diuresis had no affect on sweat rate during exercise (D = 0.80 vs. H = 0.80 liters/hr), body heat dissipation appeared limited mainly by a reduction in peripheral blood flow. The diuretic induced dehydration was found to increase the sensitivity of some subjects to the exercise-heat stress, producing symptoms of heat exhaustion.

Adult↗
PubMed1976

Studies concerning dopamine diuresis in the rat.

Dopamine is both diuretic and saluretic in the conscious rat. The diuretic effect does not appear to be beta-receptor mediated, but rather may be the result of a combination of alpha- and dopaminergic receptor stimulation. Conclusive proof for the existence of the latter, however, must await the discovery of a more selective peripheral dopamine-receptor stimulant than is dopamine per se.

Animals↗
PubMed1993

Central hemodynamic effects of diuretic therapy in chronic heart failure.

In chronic heart failure diuretic drugs improve central hemodynamic variables and cardiac pumping secondary to altered plasma and extracellular volumes; humoral markers of these changes include increased plasma renin and aldosterone levels. The latter increases are maximal over the first week but decline with chronic therapy. The plasma alpha-ANP levels show a reciprocal effect; these data are compatible with a rapid contraction of the plasma volume which is sustained during chronic therapy. The acute hemodynamic actions of diuretic agents reflect both immediate and direct vascular actions and also effects secondary to diuresis (volume redistribution). At rest substantial reductions in pulmonary "wedge" pressure (-29%), with a consequent fall in cardiac output (-10%), are described. Total systemic vascular resistance initially increases but "reverse autoregulation" over subsequent weeks returns this elevation gradually towards control values. Tolerance to these initial hemodynamic effects does not occur with maintained therapy; moreover, echocardiographic markers of contractility and exercise capacity may increase. The early venodilator effects of diuretic drugs can be attributed to prostaglandin release and the initial pressor actions to activation of the renin angiotensin system; these vascular actions may have limited relevance to long-term beneficial effects on hemodynamics. Direct pulmonary vasodilation and improved pulmonary compliance remain an interesting finding. Although most patients are both symptomatically and hemodynamically improved at rest, the actions during exercise are more varied. Some individuals with severely impaired left ventricular function show little hemodynamic improvement, whereas those with milder dysfunction usually benefit; in the main this is probably related to the latter being on a steeper cardiac function curve.(ABSTRACT TRUNCATED AT 250 WORDS)

Bumetanide↗
PubMed1976

Diuretics in malignant effusions and edemas of generalized cancer.

Forty patients with generalized cancer complicated by water and electrolyte retention were treated with "medium" and "large" doses of furosemide and bumetanide with 35% and 40% objective positive response, respectively. A smaller percentage of patients benefited from these diuretics, mainly in the quality of their lives. Peaks" of diuresis lasting a few days were observed in positive diuretic response. It is therefore concluded that diuretics may be more effective in malignant conditions if administered in a "high-dose pulse" therapeutic schedule.

Ascites↗
PubMed1988

Diuresis from atrial receptors after hypophysectomy and local ablation with no changes in plasma vasopressin.

Stimulation of the left atrial receptors in dogs anaesthetized with chloralose results in a reflex diuresis and natriuresis. The efferent limb of this reflex is though to have at least three components: nervous, haemodynamic and humoral. The present study was designed to investigate the humoral component in dogs anaesthetized with chloralose; to determine whether a humoral agent, other than vasopressin, might be causative in this reflex diuresis. The nervous and haemodynamic components were prevented by pharmacological denervation. Any possible contribution to the diuresis by a decrease in the plasma concentration of vasopressin was prevented by the removal of the pituitary gland. In animals in which a spontaneous diuresis followed hypophysectomy, an infusion of arginine vasopressin sufficient to maintain urine flow in the normal range for these dogs anaesthetized with chloralose was given. Distension of small balloons at the pulmonary vein-atrial junctions and in the left atrial appendage discretely to stimulate the atrial receptors in eleven dogs anaesthetized with chloralose resulted in a significant diuresis. It was concluded that a blood-borne agent other than vasopressin was responsible for the observed diuresis. At the moment it is not known whether vasopressin or the diuretic agent, or both, are involved in the diuresis accompanying the stimulation of atrial receptors.

Animals↗
PubMed1989

[Metolazone in the treatment of refractory heart insufficiency. Experience of 10 cases].

OBJECTIVE: To evaluate efficacy of the association furosemide-metolazona in ten retrospective cases of Congestive heart failure, furosemide resistant. SETTING: Service of cardiology, patients admitted in two year period, from September 1985 through May 1987. PATIENTS: Revision of ten cases of congestive heart failure who was administered metolazona after inadequate response to furosemide. The etiology of congestive heart failure included three cases of ischemic heart disease, two cases of dilated myocardiopathy, two cases of rheumatic valvular cardiopathy, one case of congenital heart disease, two cases with no established etiology. All cases was in functional class III and IV of NYHA classification. RESULTS: Good results were obtained in eight patients. The other two were not different in etiology of heart failure, renal function, serum electrolytics and associated therapy. Diuresis was independent of the creatinine plasmatic values. CONCLUSION: In our study, in eight of ten cases, metolazona had additive diuretic effect when associated to furosemide in patients with congestive heart failure.

Aged↗
PubMed1970

Renal tubular flow dynamics during angiotensin diuresis in the rat.

1. Tubular size and lissamine green transit times were measured in rat kidneys undergoing a diuretic response to angiotensin II (0.5 mug/kg per min), and compared with the changes observed during diuresis induced by osmotic diuretics, noradrenaline and chlorothiazide.2. Angiotensin always caused a marked prolongation in proximal and distal tubular transit times; individual distal convolutions were coloured for prolonged periods, and lissamine green appeared in high concentration in distal tubules.3. Marked changes were observed in superficial tubular calibre during a stable diuretic response to angiotensin. Where distal tubular diameter was normal for the rate of urine flow, proximal tubular volume was generally reduced. In a number of experiments, however, distal tubules were markedly dilated, and in these cases proximal tubular volume was also often increased. Angiotensin may therefore be capable of causing a degree of internal hydronephrosis in the rat kidney.4. Prolongation of dye transit times, and the appearance of a concentrated lissamine green bolus in distal tubules, was suggestive of a decreased superficial nephron flow rate, indicating that the diuretic effect of angiotensin may take place only through deeper nephrons.

Angiotensin II↗
PubMed1996

[Diuretics].

Diuretics have been empirically developed. Inorganic mercury was used as diuretics from 16C. Guy's Hospital Pills (containing the equal part of Hg2Cl2, digitalis, and squill) was well known in the 19 C. Discovery of the diuresis of merbaphen has led to develop many organomercurial diuretics and to give suggestion of the drug design of ethacrynic acid. Diuresis in patients given sulfonamide was discovered in 1938. Inhibition of carbonic anhydrase by sulfonamide was related to its diuresis. Drug design aimed to enhance the inhibition of this enzyme has obtained acetazolamide, then chlorothazide. But, the discovery of remarkably enhanced diuretic activity (decreased inhibition on the enzyme) of hydrochlorothazide changed this drug design to rondom chemical modification of thiazide ring. Then, furosemide and other loop diuretics were obtained. The structure-activity relationship of thiazides using the electronic state and other physico-chemical indices was studied by us. A large hydrophobic center linked to a positive formal charge was assumed to the receptor of thiazide. Binding of thiazide to erythrocyte which gives mild and long acting diuretic property was found by us. Recently, shut down of the tubuloglomerular feedback by loop diuretics was reported. Loop diuretics are metabolized to loss their activity. Therapeutic drug monitoring is necessary to obtain a desirable diuresis. By wide clinical use of thiazides and loop diuretics, patients with hyponatremia with eu-or hypervolemic increased. I have proposed aquaretics since 1976. In 1992, nonpeptide selective vasopressin V2 receptor antagonist (OPC-31260) was first synthesized in Japan. This has been found to cause hypotonic diuresis and elevation of serum Na level in men. The combined use of loop diuretics and aquaretics should be considered.

Animals↗
PubMed1984

[Incidence of lithiasic recurrence after a diuretic therapy, alone or combined with treatment by a thiazide diuretic or phosphorus].

The preventive affects on recurrent renal calcium stones of water diuresis alone or combined with drugs aimed at lowering urinary calcium were evaluated prospectively in 51 patients with calcium nephrolithiasis. Following clinical and metabolic examination, the patients were allocated at random to 3 treatment groups: water diuresis alone (group I, n = 19) or associated with hydrochlorothiazide 50 mg/day (group II, n = 19) or with a neutral phosphate preparation 1500 mg/day (group III, n = 13). Results were assessed on the number of recurrences; 24-h urinary calcium was measured at regular intervals. The mean follow-up (2 years; range 1-4 years) was the same in all 3 groups. A significant fall in recurrence rate as compared with pre-treatment values was observed in groups I and II. The recurrence rate was the same in both groups during treatment. However, less patients had recurrences in group I (1/19) than in group II (5/19). No significant fall in recurrence rate was observed in group III, owing to some patients in this group having frequent recurrences. The recurrence rate was unrelated to clinical findings and biochemical values ( oxaluria , calciuria) measured before treatment and to the urinary Ca/Cr ratio calculated during treatment. This study confirms that water diuresis is effective in preventing recurrent renal calcium stones and that diuretics of the thiazide group reduce the number of patients with recurrences.

Adult↗
PubMed1983

Coupling between renal tubular secretion and effect of bumetanide.

The relationship between renal tubular secretion of bumetanide and its saluretic effect was studied in six healthy subjects before and after probenecid (1 gm IV). Bumetanide was determined in serum and urine by HPLC. Continuous intravenous infusion of bumetanide (200 micrograms/hr) gave an average diuresis at steady state of 15 +/- 3 ml/min. Corresponding plasma concentration, urinary excretion rate, and renal clearance of bumetanide averaged 14.3 +/- 2.3 ng/ml, 64 +/- 31 micrograms/30 min, and 145 +/- 59 ml/min. After probenecid there was a marked change in bumetanide kinetics. Average plasma concentration rose to 41.7 +/- 8.1 ng/ml, whereas renal clearance and urinary excretion rate fell to 15.1% and 29.5% of control. There was also a concomitant decrease in diuresis and saluresis to 47% and about 40% of control. Probenecid also reduced the renal clearance of para-aminohippurate and inulin to 67% and 75% of control. Since the fractional water and sodium chloride excretion was also reduced about 33% and 42%, it is concluded that a large part of the diuretic effect of bumetanide depends on its active tubular secretion. As with furosemide and piretanide, bumetanide diuresis is elicited from the luminal side of the human nephron.

Adult↗