Mechanism of action of diuretics
- D Craig Brater, MD
D Craig Brater, MD
- Emeritus Dean, Indiana University School of Medicine
- Vice President for Programs, Regenstrief Foundation
- Section Editors
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor of Medicine
- University of Rochester School of Medicine and Dentistry
- Michael Emmett, MD
Michael Emmett, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Chief of Internal Medicine
- Baylor University Medical Center
Diuretics are among the most commonly used drugs. They act by diminishing sodium reabsorption at different sites in the nephron, thereby increasing urinary sodium and water losses. The ability to induce negative fluid balance has made diuretics useful in the treatment of a variety of conditions, particularly edematous states and hypertension.
A review of the mechanism and time course of action of diuretics will be presented here. Diuretic dosing and adverse effects are discussed separately. (See "Loop diuretics: Maximum effective dose and major side effects" and "Time course of loop and thiazide diuretic-induced electrolyte complications".)
MECHANISM OF ACTION
The diuretics are generally divided into four major classes, which are distinguished by the site at which they impair sodium reabsorption [1,2]:
●Loop diuretics act in the thick ascending limb of the loop of Henle
●Thiazide-type diuretics in the distal tubule and connecting segment (and perhaps the early cortical collecting tubule)
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