Lidres, Eunice Kay BSPMY 3 TINCTURE B Endterm Activity 4

DIURETICS: A Review

The journal, “Diuretics - a review,” was written by David Wile in 2012. It

states that diuretics are one of the most commonly used drugs. Wile (2012),
gave a detailed description about the role of the kidney in water homeostasis
and how diuretics work.

In addition, he also presented the classes of diuretics and how their

mechanism of action. First, the loop diuretics block the sodium-potassium-
chloride symport and it is thought that these agents bind the chloride-binding
site that lies within the symporter’s transmembrane domain. One important
thing to take note is that loop diuretics has a general feature of ototoxicity.
Second, thiazides and other thiazide-like diuretics inhibit the sodium-chloride
symporter located in the cortical portion of the ascending loop of Henle and
the distal convuluted tubule, where they bind competitively to the chloride
binding site. Third, the potassium-sparing diuretics cause reductions in
potassium and hydrogen excretion that will result to hyperkalemia and
metabolic acidosis. This is because of the inhibition of sodium reabsorption in
the late distal tubule and collecting duct. Fourth, the carbonic anhydrase
inhibitors noncompetitively inhibit carbonic anhydrase in the proximal tubule.
Lastly, the osmotic diuretics like the mannitol increases the tubular fluid
osmolality, which decreases water reabsorption to those sites in the nephron
which have AQP water channels.

In general, diuretics limits water reabsorption and results in a diuresis by

decreasing renal tubular sodium reabsorption, thus reducing the luminal-
cellular osmotic gradient. According to Wile, diuretics are use in cases where
there is oedema or even non-oedematous. This oedema can be seen in
patient with heart failure, renal failure and nephrotic syndrome. Those non-
oedematous states are those patient with hypertension, nephrolithiasis,
hypercalcaemia and diabetes insipidus. Setting aside the clinical uses of
diuretics, its side effects are also to be noted. Hyponatremia can occur
especially in thiazide diuretics, hyperkalaemia, metabolic alkalosis, and
hypomagnesaemia among others.
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Throughout my reading of the journal, David Wile coherently focuses on the

topic. He clearly stated every important details that the physician and other
healthcare professionals should be aware of about diuretics. One of those is
when in co-administering Bendroflumethiazide and vitamin D or calcium since,
it is known to cause calcium retention. On the other hand, this
hypercalcaemia can be treated by furosemide which increases urinary calcium
excretion. He also did an excellent description of most if not all of the clinical
uses of diuretics. He expressed that although diuretics is commonly used in
hypertension its effectiveness does not always relate to its diuretic effect. This
journal helps me to understand more of the mode of action of diuretics.
Since, at first thought I have known diuretics are those drugs that only helps
a person to urinate if they have renal problems. I also found what the author
said about furosemide as a diagnostic agent in distal renal tubular acidosis
significant. It is reassuring to know that future developments are to take
place. With that, newer diuretic drugs will be available with a wider range of
clinical applications. I conclude that, with all the results and scientific facts
that David Wile presented, reading this journal was worth every minute.