What are diuretics in treatment. Diuretic - what is it? Classification and principle of action of diuretics. Side effects on the body

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What are diuretics is often asked by a doctor. Diuretics are diuretics with different mechanisms of action that have a pronounced diuretic effect. Unfortunately, they all have side effects and their use without a doctor's recommendation is dangerous to health. What diuretics are there?

Classification - types of diuretics

Modern diuretics diuretics are one of the greatest advances in internal medicine in the last 25 years. In nephrological practice, the following 4 groups of diuretics are used:

thiazide diuretics (benzothiazidine derivatives - thiazides);
loop diuretics - furosemide and ethacrynic acid;
potassium-sparing diuretics;
osmotic diuretics.

Some classic diuretics are never used for kidney disease due to nephrotoxicity (mercury diuretics) or ineffectiveness (theophylline, ammonium chloride).

Thiazide diuretics

The thiazide group of diuretics - hypothiazide (dichlothiazide, hydrochlorothiazide), cyclomethiazide and others inhibit sodium reabsorption in the cortical section of the nephron loop, and also partially in the distal part of the convoluted tubules. The diuretic effect develops within 1 - 2 hours, lasts 10 - 12 hours or more, so it is better to take the drug in the morning. Hypothiazide is prescribed 25 - 100 mg (1 - 4 tablets) / day, cyclomethiazide - 0.5 - 1.5 mg (1 - 3 tablets) / day. The thiazide group also includes brinaldix (take 20-60 mg per day), chlorthalidone (take 25-100 mg in the morning on an empty stomach; has a long-lasting effect), renez (prescribe 0.5-2 milligrams).

The saluretic effect of this group of diuretics is moderate, about 10% of filtered sodium is released. However, despite the moderation of the diuretic effect, the drugs are widespread, since they are easy to use, have a hypotensive effect, and also improve the course of nephrogenic diabetes insipidus and idiopathic hypercalciuria.

Localization of the action of diuretic drugs in the nephron

Side effects of thiazide diuretics:

1. Increase the excretion of potassium with the development of hypokalemia, sometimes metabolic alkalosis, increase the excretion of magnesium
2. Reduce the excretion of calcium in the urine - increase its serum content (this is the basis for their use for the treatment of idiopathic hypercalciuria).
3. Reduce (reversibly) excretion of uric acid with the development of hyperuricemia.
4. Disrupt carbohydrate metabolism, leading to hyperglycemia, as well as a worsening of the course of diabetes mellitus (why their use for diabetic nephropathy is limited). They can worsen renal failure, therefore, with severe chronic renal failure, the use of these drugs is contraindicated. The side effects of a diuretic include cases of pancreatitis, allergic reactions with photosensitivity, or necrotizing angiitis.

Loop-type diuretics

Furosemide has a depressing effect on the active reabsorption of chlorine, acts mainly in the ascending part of the nephron loop, as well as (in high doses) in the proximal tubules. It has a quick, short-term and pronounced diuretic effect, 20-30% of filtered sodium is excreted in the urine. Even when taking the drug inside, it is absorbed quickly and completely. The diuretic effect begins less than 1 hour after administration, quickly (in 15 - 20 minutes) reaches a maximum and lasts for 4 hours. After intravenous administration, the diuretic effect is observed within a few minutes and disappears after 2 hours. In addition to the treatment of edema syndrome, this loop-type diuretic is also used in acute tubular necrosis to prevent (or alleviate) anuria.

When taking the drug orally, the initial dose is 20-40, the maximum is 400-600 milligrams, with intravenous administration, the dose of the drug ranges from 20 to 1200 mg. Unlike thiazides, furosemide slightly increases glomerular filtration, and therefore is the agent of choice in renal failure.

The diuretic is generally well tolerated. With prolonged use, hyperuricemia may develop up to acute gout, deafness (especially with the simultaneous administration of antibiotics), thrombocytopenia. The hyperglycemic effect is negligible. Very rarely (while taking antibiotics from the cephalosporin group), renal function may deteriorate. Unlike thiazides, it can cause excessive loss of sodium chloride with the development of hyponatremia.

Ethacrynic acid (uregit) is another loop-type diuretic that acts in the same way as furosemide, although it has a different chemical structure. The peak of diuresis occurs 2 hours after taking the drug inside, the diuretic effect stops after 6 - 9 hours. Assign inside, starting from 50 milligrams (1 tablet), increasing, if necessary, the daily dose to 200 mg. Take the drug after meals.

A side effect of a diuretic is hyperuricemia. In rare cases, deafness develops, very rarely irreversible (especially when taking the drug together with antibiotics).

Potassium-sparing diuretics

This group primarily includes spironolactones (aldactone, veroshpiron) - synthetic steroids, competitive antagonists of aldosterone. These drugs act at the level of the distal tubules (and possibly the collecting ducts); action is not excluded at the level of the proximal tubules. In recent years, a direct inhibitory effect of spironolactones on the secretion of aldosterone by the adrenal glands has also been shown. Despite the fact that the diuretic effect of spironolactones is weaker than thiazides (they release only about 2% of sodium filtered in the glomeruli), they are widely used, potentiating the effect of agents with a more proximal effect, inhibiting the reabsorption of sodium that has passed (under the influence of hypothiazide, furosemide) the proximal tubules ...

When used alone against the background of a normal salt regimen, potassium-sparing diuretics do not work, the effect is observed only if sodium is limited.

The diuretic effect of drugs begins after a few days. The peculiarities include a decrease in potassium reabsorption (why the appointment together with proximal diuretics, especially with thiazides, is advisable not only to potentiate the effect, but also because of the opposite effect on potassium excretion).

The daily dose of veroshpiron ranges from 25 to 200 - 300 milligrams.

Side effect: hyperkalemia, rarely drowsiness, hirsutism, gynecomastia, menstrual irregularities. Veroshpiron is not recommended for patients with severe renal failure (especially in diabetic nephropathy).

Triamterene also has a potassium-sparing property (a drug with a completely different mechanism of action, not related to the inhibition of aldosterone). Acts in the distal tubule region, rapidly inhibiting sodium transport. Diuretic ability is weaker than thiazides, and stops after 10 hours.

Prescribed in a dose of 50 - 300 milligrams, usually 200 mg in 1-2 doses (after breakfast and lunch), is often used in combination with stronger diuretics, side effects of a diuretic include uric acid retention, sometimes hyperglycemia.

The drug amiloride is similar in structure and mechanism, prescribed at a dose of 5 - 20 mg per day. When taking 5 milligrams of amiloride, the body retains more potassium than when taking 5 g of potassium chloride orally.

Osmotic diuretics

Osmotic diuretics are non-metabolizable and non-absorbed substances in the kidneys that are filtered in the glomeruli, increase the osmolarity of glomerular urine and thereby reduce tubular reabsorption.

Mannitol has found the greatest application in nephrology, but more often not in nephrotic syndrome, but for the prevention of acute renal failure or in the early stages of its development, as well as for the creation of forced diuresis in conditions threatening the development of acute tubular necrosis. Mannitol is injected slowly intravenously in the form of a 10-20% solution at the rate of 0.5-1 g / kg of body weight.

In case of small edema, it is sometimes enough to recommend treatment with natural remedies - infusions and decoctions of medicinal plants with diuretic properties (bearberry, juniper, parsley, lingonberry).

Diuretics optimal combinations

Since the mechanism of action of different groups of diuretics is not the same, if one drug is ineffective, it should be replaced with another or combined. The following optimal combinations and treatment regimens can be recommended.

It is advisable to combine saluretics of proximal action with distal potassium-sparing agents. The combination with veroshpiron (or triamterene) is especially important when prescribing thiazides. There are official combinations of drugs, including saluretics and potassium-sparing diuretics: triampur (the tablet contains 25 mg of triamterene and 12.5 hypothiazide), furesis (the tablet contains 50 milligrams of triamterene and 40 - furosemide). You can combine drugs and close action. Thus, furosemide, administered during the period of maximum diuresis caused by thiazides, increases diuresis (at the same time, thiazides do not increase diuresis caused by furosemide). Thiazides can enhance the effectiveness of ethacrynic acid - furosemide does not have this property).

Euphyllin, with slow intravenous administration, can enhance the effect of natriuretics, being administered at the height of the peak diuresis (for example, 30 minutes after taking furosemide or ethacrynic acid).

Dangerous combinations of diuretics

It is necessary to remember about some dangerous combinations of diuretics with other drugs. The combination of ethacrynic acid or furosemide with kanamycin, gentamicin, streptomycin can lead to deafness. The combination of ethacrynic acid or furosemide with cephaloridin is nephrotoxic. When diuretics are combined with acetylsalicylic acid, its secretion by the kidneys is disrupted. If you combine diuretics and calcium supplements at the same time, hypercalcemia may develop.

1) in order to reduce the loss of potassium in the urine, treatment should be started with verospiron or triamterene;
2) add thiazide diuretics after 2 - 3 days;
3) if ineffective, replace thiazides with furosemide or ethacrynic acid. Double the dose of furosemide every day until diuresis occurs or until a dose of 4000 milligrams per day is reached;
4) if diuresis does not occur, continue taking furosemide (part of the dose is administered intravenously), while increasing the blood volume by intravenous administration of albumin or salt-free dextran. The effect is even more likely if mannitol is administered intravenously at the same time. The patient must be weighed daily. This gives a much better idea of \u200b\u200bthe water balance than measuring urine output and fluid intake.

With the disappearance of edema, diuretics are canceled.

Diuretic treatment

When treating with diuretics, the following provisions should be borne in mind (we have already partially mentioned them).
These drugs can lead to hypokalemia and metabolic alkalosis. If a loop-type diuretic is prescribed, potassium supplements must be additionally used. Hypothiazide and furosemide in outpatient settings are prescribed intermittent courses (for example, 2 days a week or every other day).
Diuretic drugs can lead to a sharp loss of sodium chloride and a decrease in BCC with a resultant decrease in proximal reabsorption. Diuretics, by decreasing the BCC, lead to an increase in renin and aldosterone levels.
With a pronounced refractoriness of edema, causing pain and very unpleasant sensations to the patient, it is possible to recommend, in extreme cases, such old measures as taking laxatives (30 g of magnesium sulfate, sorbitol) puncturing the skin with sterile thick needles. In the same situations, ultrafiltration is possible (with an assessment of the risk of a subsequent decrease in CF).
In severe hyperaldosteronism, oral potassium intake without the addition of veroshpiron does not affect hypokalemia.
Patients with prolonged refractory edema who have been taking diuretics for a long time often develop hyponatremia (the total sodium content in the body can be increased in this case). A decrease in sodium level is combined with peripheral vascular insufficiency (hypovolemic shock), secondary hyperaldosteronism, a decrease in potassium content, alkalosis, a decrease in CF, an increase in urea concentration.
At a CP of less than 20 ml / min, the agent of choice is furosemide, which makes it possible to increase the intake of table salt (sodium chloride), possibly increasing CP. Veroshpiron and triamterene should not be prescribed because of the danger of hyperkalemia.
When treating patients with CRF, it should be remembered that fluid loss with a subsequent decrease in BCC can lead to further deterioration of renal function. More easily electrolyte disturbances occur - hyperkalemia, hypochloremia, alkalosis, hypercalcemia, as well as hyperuricemia and hyperglycemia. With large doses of furosemide and ethacrynic acid, hearing impairment (usually transient) may occur.

Diuretics or diuretics are often used to treat various pathological conditions provoked by excessive accumulation of fluid in the body. Their action is based on slowing down the absorption of salts and water in the renal tubules, thereby increasing the amount of urine and the rate of its excretion. Diuretics are a large list of drugs that help reduce fluid content in tissues and relieve swelling in various diseases, including arterial hypertension.

Diuretics are drugs of synthetic or herbal origin, which are designed to increase the excretion of urine by the kidneys. Due to the action of diuretics, the excretion of salts from the body is significantly increased, the amount of fluid in the tissues and cavities decreases. These drugs are widely used in the treatment of hypertension, mild heart failure, liver and kidney diseases associated with circulatory disorders.

However, despite the wide list of pathologies that diuretics help to cope with, it is not recommended to take them without a doctor's prescription. The wrong dosing regimen or the frequency of administration can lead to serious complications. Below is a list of diseases and pathologies in the treatment of which diuretics are used:

hypertension;
cardiac edema;
cirrhosis;
glaucoma;
acute renal or heart failure;
high secretion of aldosterone;
diabetes;
metabolic disease;
osteoporosis.

The mechanism of action of diuretics

The effectiveness of diuretics in hypertension is directly related to their ability to reduce sodium levels and dilate blood vessels. It is the maintenance of blood vessels in tone and a decrease in fluid concentration that help to stop hypertension. High blood pressure diuretic tablets are most often prescribed for elderly patients.

In addition, taking diuretics helps to relax the myocardium, improves blood microcirculation, reduces platelet adhesion, and reduces the load on the left ventricle of the heart. Due to this, the myocardium requires less oxygen for proper functioning. Also, diuretics can have an antispasmodic effect by relaxing the smooth muscles of the bronchi, arteries, and biliary tract.

Classification and types of diuretics

What are diuretics is now clear, but you need to understand what types of diuretics exist. They are conventionally classified according to several criteria: by efficiency, duration of action, and also by the speed of onset of the effect. Depending on the patient's condition and the complexity of the disease, the doctor selects the most suitable drug.

By efficiency:

strong ("Lasix", "Furosemide");
medium ("Hygroton", "", "Oxodolin");
weak ("Diakarb", "Veroshpiron", "Triamteren");

By the speed of action:

By duration of action:

long (about 4 days) - "Veroshpiron", "Eplerenone", "Chlorthalidon";
medium-term (no more than 14 hours) - "Hypothiazide", "", "Indapamide", "Klopamid";
short-acting (less than 8 hours) - "Furosemide", "Lasix", "Manit", "Ethacrynic acid".

There is a separate classification depending on the pharmacological effect of the drug.

Thiazide diuretics

This type of diuretic pill is considered one of the most common. They are prescribed most often, since the therapeutic effect is achieved within a few hours. The average duration of their action is 12 hours, which allows you to set a one-time daily intake. These drugs are quickly absorbed in the intestines and are well tolerated by patients. One of the advantages of such diuretics is that they maintain the acid-base balance of the blood.

The action of thiazide diuretics is as follows:

the reabsorption of sodium and chlorine is suppressed;
the excretion of magnesium and potassium is significantly increased;
excretion of uric acid decreases.

Thiazide diuretics - a list of effective drugs:

Chlorthalidone;
"Indap";
"Hypothiazide";
Cyclometazide;
"Indapamide";
"Klopamid".

They are prescribed for various diseases of the liver and kidneys, essential hypertension, glaucoma and other pathologies associated with excessive fluid content in the body.

Potassium-sparing drugs

This type of diuretic is considered to be more gentle, since it promotes potassium retention in the body. They are often prescribed in conjunction with other medications to enhance the effects of the latter. This type of diuretic effectively reduces systolic pressure, therefore they are used for the treatment of hypertension in combination with other drugs. Their use is also shown when edema of various etiologies and heart failure appear.

Potassium-sparing drugs include: "Aldactone", "Amiloride". These diuretics should be taken with caution, as their hormonal effects cause side effects. Male patients may develop impotence, women - menstrual irregularities, pain in the mammary glands, bleeding. With a long course of high doses, hyperkalemia may occur - a large amount of potassium gets into the blood. This condition can cause cardiac arrest or paralysis.

Important: The use of potassium-sparing diuretics is especially dangerous in patients with renal insufficiency and diabetes mellitus. These medicines should only be taken under medical supervision.

Loop diuretics

Loop is considered the most powerful diuretic drugs. They act on the Gengle loop - the renal tubule directed towards the center of the kidney and performs the function of reabsorbing fluids and minerals. These diuretics work as follows:

reduce the reabsorption of magnesium, potassium, chlorine, sodium;
increase blood flow in the kidneys;
increase glomerular filtration;
gradually reduce the volume of extracellular fluid;
relax the vascular muscle.

The action of loop diuretics occurs quickly enough, after only half an hour and lasts up to 6-7 hours. This type of drug is rarely prescribed, only in especially critical cases, since they have many side effects.

Loop diuretics, a list of the most popular:

Osmotic diuretics

The action of diuretics of this kind is to reduce the pressure in the blood plasma, which leads to a decrease in swelling and the elimination of excess fluid. At the same time, the movement of blood in the renal glomeruli becomes higher, which contributes to an increase in filtration. Below are the names of diuretic pills that work on this principle:

Mannit;
Mannitol;
"Urea";
Sorbitol.

"Mannit" has a long-term effect, which cannot be said about other drugs in this group. Medicines of this series are used exclusively in acute cases. They are prescribed if the patient has developed the following pathological conditions:

Osmotic diuretics are potent drugs. That is why they are prescribed one-time, and not as a course therapy.

Carbonic anhydrase inhibitors

One of the drugs in this group is Diacarb. Under normal conditions, carbonic anhydrase helps in the formation of carbonic acid in the kidneys from carbon dioxide and water. Diacarb blocks the production of this enzyme, helping to wash out sodium, which in turn pulls water with it. At the same time, potassium is lost.

Diacarb has a weak effect that develops relatively quickly. The duration of its action can be about 10 hours. This drug is used if the patient has:

increased eye pressure;
gout;
poisoning with barbiturates or salicylates.

Aldosterone antagonists

This type of drug helps to block aldosterone receptors, as a result of which the hormone stops acting on the kidneys. As a result, the reabsorption of water and sodium is impaired, which leads to a diuretic effect. A frequently used agent of this type is "Spironolactone" ("Veroshpiron", "Veroshpilacton"). It is used in combination with loop or thiazide diuretics.

Recent research has revealed a new direction in the use of this drug. Blocking aldosterone receptors in the myocardium helps stop cardiac remodeling (replacement of muscle tissue by connective tissue). The use of spironolactone as part of complex therapy reduces mortality after myocardial infarction by 30%.

Another interesting feature of the drug is its ability to block testosterone receptors, which can lead to the development of gynecomastia and even impotence in men. In the female part of patients, this property of drugs is used in the treatment of diseases provoked by high testosterone levels.

Note: Diuretics containing spironolactone are potassium-sparing.

Herbal remedies

Along with drugs, herbal diuretics are often used. Their effect on the body is milder, and there are practically no side effects. Diuretics of plant origin not only promote the elimination of excess fluid, but also help saturate the body with mineral salts, vitamins, and have a mild laxative effect. Among vegetables and fruits, parsley, celery, watermelon, cucumbers, pumpkin and many other products have a diuretic effect. You can also get rid of excess fluid with the help of diuretic infusions from strawberries, birch leaves, lingonberries, tansy and shepherd's purse.

However, despite the fact that herbal diuretics are significantly inferior in effectiveness to medicinal preparations, it is also necessary to consult a doctor before using them to find out the cause of the pathology. Depending on the etiology of edema, the doctor will select the most suitable option.

Treatment with decoctions and herbal infusions is often necessary for renal edema. These funds, in addition to a diuretic, have anti-inflammatory and antibacterial effects. This is especially important in the presence of diseases of the urinary system. Among other things, herbal remedies are approved for use in pregnant women and children.

Drinking herbal teas is necessary in short courses. Long-term use can provoke addiction, and the effectiveness of therapy will gradually decrease. Also, with a long intake, it is possible to excrete important trace elements of potassium and sodium from the body. Therefore, herbal diuretics should also be used under the control of blood counts.

Side effects

Another reason why only a doctor should prescribe diuretics is to balance the benefits and harms of drugs. Depending on the severity of the pathology, the doctor will decide whether to use certain drugs. A careful approach when choosing medications will minimize the risk of developing unpleasant side effects.

The most common problems when taking diuretic tablets were:

lowering blood pressure, sometimes to very low levels;
general weakness, increased fatigue;
dizziness or headaches;
feeling of "goose bumps" on the skin;
photosensitivity;
the development of anorexia;
increased blood sugar;
the appearance of dyspeptic symptoms;
nausea, vomiting;
cholecystitis;
pancreatitis;
changes in blood composition (decreased platelets, increased lymphocytes and monocytes);
decreased sexual function.

Even if previously, when taking diuretics, side effects in the patient were not recorded, then you should still not take these drugs without a doctor's prescription. Uncontrolled use of such medications can lead to serious and often irreversible complications.

Contraindications

The use of diuretics must be treated very carefully. These medicines have many contraindications listed in the instructions for them. They categorically cannot be taken if:

there is an intolerance to one of the components of the drug;
pregnancy confirmed;
diagnosed with diabetes mellitus;
edema caused by decompensated cirrhosis of the liver;
there is renal or respiratory failure;
hypokalemia is observed.

Relative contraindications are:

ventricular arrhythmia;
insufficient heart activity;
taking lithium salts;
the use of cardiac glycosides.

In addition, caution is advised when combining high pressure diuretic tablets with ACE inhibitors. With the simultaneous administration of these drugs, the effect of diuretics is significantly enhanced, which can lead to a sharp drop in blood pressure and dehydration.

Still have questions? Ask them in the comments! A cardiologist will answer them.

Diuretics are used in the complex therapy of many ailments.A diuretic, what it is and how to take it, you need to ask your doctor.

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Classification principles

Diuretic medicines are a group of drugs that have pronounced diuretic effects. The diuretic effect is the ability of substances to cause accelerated filtration of blood in the nephron channels, removal of excess fluid from the body. This effect of drugs is achieved through different mechanisms of action, which is the basis for the classification of diuretics.

The main groups of diuretic medicines:

1. Loop diuretics (Furosemide, Ethacrynic acid).
2. Thiazide diuretics (benzothiazine derivatives - Thiazides).
3. Potassium-sparing medicines.
4. Osmotic drugs.

But not all representatives of classical diuretics are used in nephrology. Some drugs are prohibited due to their nephrotoxicity (mercury diuretics) and ineffectiveness (Theophylline, Ammonium chloride).

Thiazide medicines

The representatives of the group include diuretics: Hypothiazide, Dichlothiazide, Hydrochlorothiazide, Cyclomethiazide. The mechanism of action is based on the suspension of sodium reabsorption in the cortical and distal parts of the nephron loop. The action of the drug begins within an hour after their use, the duration of the effect is 12 hours or more, therefore, it is better to take each thiazide agent of this group once a day in the morning.

Thiazide diuretics include:

Brinaldix;
Chlorthalidone is a long-acting drug;
Renaise.

The release of sodium while taking these drugs is moderate (up to 10% of filtered sodium is released). Drugs are widely distributed due to the following characteristics:

ease of use;
hypotensive effect;
efficacy in the treatment of nephrogenic diabetes insipidus, idiopathic hypercalciuria.

Side effects from taking thiazides:

increased excretion of potassium with the development of hypokalemia and magnesium, the development of metabolic alkalosis is possible;
a decrease in the excretion of calcium in the urine, an increase in its concentration in the blood plasma;
increase the risk of developing hyperuricemia due to a decrease in the excretion of uric acid;
worsen the course of diabetes mellitus, since they disrupt the metabolism of carbohydrates, causing hyperglycemia;
increase renal failure;
contribute to the development of toxic pancreatitis;
allergic manifestations with episodes of photosensitivity, necrotizing angiitis.

Loop group drugs

A prominent representative of this group is Furosemide. It has a depressing effect on the active reabsorption of chlorine ions. The site of its action is the ascending part of the nephron, and when large doses are used, the proximal tubules.

The drug has a quick, pronounced, but short-term effect. Its effect begins less than an hour after consumption. The maximum effect occurs within 20 minutes, the duration of the action is about 4 hours.

With parenteral administration, the action of the drug begins immediately and lasts up to 1 hour. Unlike thiazides and thiazide-like medicines, Furosemide improves filtration in the glomeruli, therefore it is considered the drug of choice in case of renal failure.

It is well tolerated by patients, but it is not recommended to take it for a long time. There is a risk of developing the following pathologies:

hyperuricemia;
acute gout;
deafness (especially with the simultaneous use of antibiotics);
thrombocytopenia;
violations in the work of the kidneys (with the simultaneous use of antibiotics from the cephalosporin group);
hyponatremia.

The drug has little effect on carbohydrate metabolism. Uregit (or Ethacrynic acid) is a lesser known representative of the loop diuretic group. It has a different chemical structure, but its mechanism of action is similar to Furosemide. The peak of diuresis occurs two hours after taking the drug, the effect lasts up to 9 hours. It is better to take the drug after meals in the morning. The negative manifestations of Uregit include:

hyperuricemia;
deafness (develops with the simultaneous use of antibiotics).

Potassium-sparing group of diuretics

Representatives of this group include drugs: Spironolactone, Aldactone, Veroshpiron. All of them are artificial synthetic steroid hormones, competitive antagonists of aldosterone. They act at the level of the distal tubules, collecting ducts, and proximal tubules of the nephron. Spironolactone can directly inhibit the formation and release of aldosterone in the adrenal glands.

The diuretic effect of such drugs is very weak (they are able to excrete only 2% of all sodium, which is filtered in the kidneys). Such medicines are often used in the complex treatment of various ailments. These funds have the ability to potentiate the action of other drugs on the proximal tubules, reducing the reabsorption of sodium that has passed the proximal parts of the nephrons.

Keeping the usual salt diet, the isolated intake of potassium-sparing medicines will not work. For the effect of taking such drugs, it is necessary to limit sodium intake. The diuretic effect of taking these funds occurs gradually, starting from 2-3 days. The uniqueness of the drugs is that they increase the reabsorption of potassium back into the blood, so doctors often prescribe Spironolactone together with proximal diuretics (thiazides and thiazide-like drugs). This scheme leads to the potentiation of the effect, prevents the development of hypokalemia, keeping potassium in the body.

Effective drugs

The daily dose of Veroshpiron is from 25 to 300 ml. While taking Spironolactone, the following adverse reactions may develop:

increased potassium in the blood;
fast fatiguability;
constant sleepiness;
hirsutism;
gynecomastia;
interruptions in the menstrual cycle.

The drug should not be taken in patients with advanced renal failure (especially in the presence of diabetic nephropathy). Potassium-sparing drugs also include Triamteren. It acts in the area of \u200b\u200bthe distal tubules, affects only sodium transport. Triamterene is not involved in the exchange of aldosterone in the kidneys. The drug has a weak diuretic activity, which lasts up to 10 hours after administration.

The dose of Triamteren medication can be from 50 to 300 ml per day. It is prescribed in two steps, combined with stronger diuretics. Adverse reactions of the drug include episodes of increased glucose and uric acid in the blood. Experts attribute Amiloride to Triamteren similar in chemical structure and action. Its daily dosage is 5-20 mg.

Osmotic substances

Representatives of this group are not at all amenable to metabolism, they are not absorbed in the kidneys. They are only filtered in the structures of the nephron, increasing the osmolarity of urine in the nephron. This explains the decrease in reabsorption in the structures of the nephron.

Mannitol is often used in nephrological practice. It is used to prevent the development of acute kidney failure or at the earliest stages of its development. Mannitol is used for forced diuresis when acute tubular necrosis is suspected. The drug is used only for parenteral administration, injected slowly, intravenously 10-20% solution.

To combat small edema, prevent their development, you can use decoctions of medicinal herbs that have diuretic properties. Herbal decoctions are often used:

bearberry;
juniper;
parsley;
lingonberries.

Differences in pharmacokinetics

Each group of these funds has different mechanisms of action.

If one drug is ineffective, use another or switch to their combination.

Approximate diuretic treatment regimens:

1. Saluretics with proximal action and distal potassium-sparing medicines. It is best to combine Veroshpiron, Triamteren with thiazides. Ready-made combined medicines (Triamterene and Hypothiazide or Triamterene and Furosemide) are presented on the modern pharmaceutical market.
2. A combination of drugs with a similar effect against the background of the peak of thiazide activity is injected with Furosemide, Ethacrynic acid is enhanced by the introduction of thiazides, Euphyllin, when administered intravenously, significantly enhances the effect of Natriuretics (Furosemide, Ethacrynic acid).

Dangerous combinations of diuretic medicines:

1. Ethacrynic acid, Furosemide is dangerous to combine with Kanamycin, Gentamycin, Streptomycin due to the risk of deafness.
2. Ethacrynic acid, Furosemide is dangerous to combine with Cephaloridin due to increased nephrotoxicity.
3. The combination of diuretics with acetylsalicylic acid disrupts the secretion of the latter by the kidneys.
4. Simultaneous intake of diuretics together with calcium can provoke the development of hypercalcemia.

Based on the works of N.E. de Wardener (1973) developed a sequence diagram for the use of diuretic medications:

1. Veroshpiron, Triamterene in the first few days to preserve potassium.
2. Then the addition of thiazides.
3. If their effectiveness is poor, thiazides are replaced by Furosemide, Ethacrynic acid. Their dosage is doubled daily until the onset of maximum diuresis.
4. To enhance the effect, a certain dose of Furosemide can be used parenterally.
5. It is also possible to connect intravenous administration of Mannitol.

For a better understanding of the state of the patient's water balance, it is advised to weigh him every day. This is more visual than measuring urine output and fluid intake for each day. After the elimination of puffiness, the intake of diuretics is canceled.

1. Most diuretic medicines can cause hypokalemia, metabolic alkalosis. To prevent this condition, you should additionally take potassium. Hypothiazide, Furosemide is best used in short, intermittent courses (2 times a week every other day).
2. With the uncontrolled use of such medicines, there may be a sharp loss of chlorides, a fall in the BCC, and a decrease in reabsorption. This will lead to increased secretion of renin, aldosterone.
3. Persistent edema can be eliminated by using laxatives (sorbitol, magnesium sulfate) by puncturing the skin with sterile needles, by ultrafiltration of blood (with an assessment of the risk of a sharp decrease in CF).
4. Severe hyperaldosteronism is treated with the simultaneous use of potassium, Veroshpiron.
5. With long-term persistent edema there is a risk of developing hyponatremia, vascular insufficiency in the periphery, hyperaldosteronism, a drop in the concentration of potassium in the blood, alkalosis, a decrease in CF, an increase in the content of uric acid.
6. Against the background of a sharp decline in CF, the drug of choice Furosemide (it acts on CF, enhancing it). Veroshpiron, Triamteren is dangerous to use due to the risk of hyperkalemia.
7. When treating CRF with diuretics, it is important to remember the risk of even greater failure of the kidneys. In such patients, it is necessary to constantly monitor the level of potassium, chlorine, calcium, uric acid and glucose in the blood.
8. With long-term use of significant doses of Furosemide, Ethacrynic acid, there is a risk of hearing loss (often transient).