Chapter 09 - Volume, Edema, and the Clinical Use of Diuretics

Abstract

Diuretics are important clinical tools used for the treatment of hypervolemic states and hypertension. Classes of diuretics are defined by either the location within the nephron at which inhibition occurs or their mechanism of action and include carbonic anhydrase inhibitors, sodium-glucose transporter inhibitors, thiazides, loop diuretics, epithelial sodium channel inhibitors, mineralocorticoid antagonists, osmotic diuretics, and vasopressin receptor antagonists. An understanding of normal kidney sodium balance is necessary to ensure adequate dosing parameters. Therapeutic indications, dosage nuances, concurrent chronic disease processes and adverse effects often dictate which class of diuretic is initially utilized. Diuretic resistance has resulted in adaptation of the treatment paradigm and often requires combination therapy for resolution. Isolated ultrafiltration devices have been evaluated but require further investigation prior to widespread use.