Diuretic Resistance

Ewout J. Hoorn, David Ellison

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Diuretic resistance is defined as a failure to achieve the therapeutically desired reduction in edema despite a full dose of diuretic. The causes of diuretic resistance include poor adherence to drug therapy or dietary sodium restriction, pharmacokinetic issues, and compensatory increases in sodium reabsorption in nephron sites that are not blocked by the diuretic. To illustrate the pathophysiology and management of diuretic resistance, we describe a patient with nephrotic syndrome. This patient presented with generalized pitting edema and weight gain despite the use of oral loop diuretics. Nephrotic syndrome may cause mucosal edema of the intestine, limiting the absorption of diuretics. In addition, the patient's kidney function had deteriorated, impairing the tubular secretion of diuretics. He was admitted for intravenous loop diuretic treatment. However, this was ineffective, likely due to compensatory sodium reabsorption by other tubular segments. The combination of loop diuretics with triamterene, a blocker of the epithelial sodium channel, effectively reduced body weight and edema. Recent data suggest that plasmin in nephrotic urine can activate the epithelial sodium channel, potentially contributing to the diuretic resistance in this patient. This case is used to illustrate and review the mechanisms of, and possible interventions for, in diuretic resistance.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Feb 23 2016

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Diuretics
Sodium Potassium Chloride Symporter Inhibitors
Edema
Nephrotic Syndrome
Epithelial Sodium Channel Blockers
Sodium
Triamterene
Epithelial Sodium Channels
Dietary Sodium
Fibrinolysin
Nephrons
Weight Gain
Intestines
Pharmacokinetics
Body Weight
Urine
Kidney
Drug Therapy

Keywords

  • Cryoglobulinemic membranoproliferative glomerulonephritis
  • Diuretic resistance
  • Edema
  • ENaC
  • Epithelial Na channel
  • Hepatitis C virus
  • Kidney disease
  • Nephrotic syndrome
  • Oral loop diuretic
  • Pathophysiology
  • Proteinuria
  • SCNN1B
  • Triamterene

ASJC Scopus subject areas

  • Nephrology

Cite this

Diuretic Resistance. / Hoorn, Ewout J.; Ellison, David.

In: American Journal of Kidney Diseases, 23.02.2016.

Research output: Contribution to journalArticle

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