Diuréticos: uso clínico racional
Resumen
En 1919, se descubrió accidentalmente la acción diurética del Merbafén, mercurial orgánico que producía aumento de la diuresis, cuando usado como droga antisifilítica (1). En adelante, mucho se ha caminado en este campo, hasta llegar a los potentes diuréticos de asa, frecuentemente usados en clínica.
Los diuréticos son drogas que aumentan la excreción urinaria de sal y agua, o sea que, producen un balance orgánico negativo de estos elementos (2). Sin embargo, esta acción es una de las predominantes de estas drogas, que como veremos tienen variados efectos adicionales, que dependiendo de una situación clínica dada, pueden ser beneficiosos o perjudiciales.
Recordando que el Nefrón, unidad anatómica y funcional del riñón, ultrafiltra unos 180 litros de plasma al día con 1 - 2 kg. de CINa, de los cuales se eliminan como orina entre 1 - 1,5 litros de agua y 5 - 10 g de CL NA al día. Es decir que, en el riñón se reabsorven más del 990/0 de estos elementos.
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1. Vogel, A. The discovery of the organic mercurial diuretics. Am. Heart J. 39;881, 7950.
2. Burg, M. Mechanisms of action ofdiuretic drugs. In The Kidney. Saunders, Philadelphia, 7976. p. 737.
3. Davies, D. L. Diuretics: mechanism of action and clinical application. Drugs, 1975.
4. Burg, Maurice ob. cit. 2.
5. Cabrera, J. Los diuréticos. Medicina Integral, 2.•373, 7981.
6. Lassiter, W.F. Disorders of sodium metabolism. In Strauss and Weft's diseases of the kidney, Little Brown, 1980. 67. Lassiter, Wi//iam E. ob. cit.
8. Maren, T. H. Carbonic anhydrase: chemistry, physiology, and inhibition. Physio/. Rev. 47:595, 1967.
9. Beyer, K. H., Baer, J. E., Michae/son, J. F., Russo, H. F. Renotropic characteristics of thacrynic acid: a phenoxyacetic sa/uretic-diuretic agent. J. Pharmaco/. Exp. Ther. 747:1, 7965.
10. Stein, J. H., Wilson, C. B., Kirkenda//, W. M. Differences in the acute effects of furosemide and etharcrynic acid in man. J. Lab. C/in. Med. 71:654, 1968.
11. Puschett, J. Be, Goldberg, M. The acute effects of furosemide on acid and electrolyte excretion in man. J. Lab. clin. Med. 77 :666, 1968.
12. De Torrente, A., Mi//er, P.D., Cronin, R. E., Rau/sen, P. E., Erickson, A. La, Schrier, R. W. Effects of furosemide and acetylcholine in norepinephrine-induced acute renal failure. Am. J. Physiol. 235:F737, 7978.
13. Burg, M. Furosemide effect on isolated perfused tubules. Am. J. Phisio/. 225:119, 1973.
14. Burg, M., Green, N. Effect of ethacrynic acid on the thick ascending limb of Hen/e's loop. Kidney /nt. 4.•301, 1973.
15. Edwards, B. R., Bear, P. G.i Sutton, R. A., Dirks, J. H. Micropuncture study of diuretic effects on sodium and calcium reabsorption in the dog nephron. J. c/in. Invest. 52:2418, 1973.
16. Eknoyam, G., Suki, W.N., Martinez-Maldonado, M. Effects of diuretics on urinary excretion of phosphate, calcium, and magnesium in thyroparathyroidectomized dogs. J. Lab. c/in. Med. 76:257, 1970.
17. Rocha, A. S., Maga/di, J. B., Kokko, J. P. Calcium and phosphate transport in isolated segments of rabbit Hen/e's loop. J. c/in. Invest. 59:975, 1977.
18. Suki, W.N., Rouse, D., Kokko, J.P. Calcium transport in the thick ascending limb (TA L) of Henle (abstract). Kidney Int. 72:467, 7977.
19. Suki, W. N., Yium, J. J., Von Mindem, M., Sa//er-Herbert, C., Ekncyan, G., Martinez-Maldonado, M. Acute treatment of hiperca/cemja with furosemide. N. Engl. J. Med. 283:836, 197b.
20. Rie//a, M. C. Principios de nefro/ogfa y disturbios hidroe/ectro/fticos. In Diuréticos. Guanabara Koogan, 7980.
21. Edwards, B. R. ob. cit.15
22. Lassiter, William, E. ob. cit. 6
23. Jorgensen, F. S., Brünner, S. The long-term effect of bendrof/umethjazide on renal calcium and magnesium excretion and stone formation in patients with recurring renal stones. Scand, J. Urol. Nephro/. 8:728, 1974.
24. Yendt, E. R., Guay, G. E, Garcia, D. A. The use of thiazides in the prevention of rena/ calcu/i. Can, Med. Assoc. J. 702:674, 7970.
25. Pak, C. Y. C. Hydrochlorothiazide therapy in nephro/ithiasis: effecy on the urinary activity product and formation product brushite. C/in. Pahrmaco/. Then 74.009, 1973. 26, Rocha, A. S. ob. cit.
27. Yendt, E. IR., Cohanim, M. Ten years' experience with the use of thiazides in the prevention of kidney stones. Trans. Am. clin Climatol. Assoc. 85: 65, 1973.
28, Popovtser, M. M., Subryan, V. L, Alfrey, A. C., Reeve, E. B., Schrier R. W. The acute effect of ch/orothiazide on serum-ionized calcium : evidence for a parathyriod hormone-dependent mechanism, J. clin. Invest. 55: 1295, 7975.
29. Pak, C. Y. c. ob. cit.25
30. Brickman, A. S., Massry, S. G, Coburn, J. W. Changes in serum and urinary calcium during treatment with hydrochlorothiazide; studies on mechanisms. J. c/in. Invest. 57:945, 1972.
31. Constanzo, L. S. On hypoca/cjuric action of ch/orothiazide. J. clin. Invest. 54:628, 1974,
32. Manitius, A., Silva, P., Epstein, F. H. Effect of hidroch/orothiazide on calcium excretion by the isolated perfused rat kidney. Proc. Soc. Exp. Biol. Med 760:760, 1979. 2033. Rie//a, M. C. ob. cit.
34. Goldberg, M. The renal physiology of diuretics. /n Handbook of physiology, section 8: renal physiology. American Physio/. Soc. Washington, D. C., 7973, p. 7003.
35. Kagawa, C., Sturtevant, F., Van Arman, C. Pharmacology of a new steroid that blocks salt activity of a/dosterone and desocycorticosterone. J. Pharmaco/. Exp. There 726:723, 7959.
36. Lidd/e, G. Specific and non-specific inhibition of minera/corticoid activity. Metabolism, 70:7021, 7967.
37. Sharp, G., Leaf, A. Effects of a/dosterone and its mechanism of action on sodium transport. In Handbook of physiology. Section 8: Rena/ physiol. Am. Physiol. Soc. Washington, D. C., 1973.
38. Benjamin, W., Singer, I. Aldosterone-induced protein in toad urinary bladder. Science, 786: 269, 1974.
39. Lessiter, Wi//iam, E. ob. cit. 6
40. Goldberg, M. ob. cit. 33
41. Baba, W., Tudhope, G., Wilson, G. Site and mechanism of action of the diuretic triamterene. C/in. Sci. 27:787, 7964.
42. Bear, J., Jones, C, Spitzer, S., Russo, H. The potassium-sparing and natriuretic activity of N-amidino-3, 5 diamino-6-chIoro pyraz/ne carboxamide hydrochloride dehydrate (ami/oride hydrochloride). J. Pharmacol. Exp. Ther, 757,472, 1967.
43. Wieb/ehaus, V., Weinstock, J., Maass, A., Brennon, F., Sosnowski, G. The diuretic and natriuretic activity of triamterene and severa/ related pteridine in the rat, J. Pharmaco/. Exp. Then 749:397, 1965.
44. Bear, J. ob. cit. 41
45. Berliner, Or/off, J. Carbonic anhydrase inhibitors. Pharmaco/. Rev. 8: 737, 7956.
46. Beyer, K., Bear, J, Physio/ogjca/ basis for the action of newer diuretic agents. Pharmaco/. Rev. 73.517, 7961.
47. Rie//a, M. C. 0b. cit?0 2048, Riel/a, M. C. ob. cit.
49. De Torrente, A. ob. cit. 12
50. Conway, J., Palmero, H. The vascular effect of the thiazjde diuretics. Arch. Intern. Med. 111,203, 1963.
51. Mudge, G. H. Diuretics and other agents employed in the mobilization of edema fluid. In the pharmacological basis of therapeutics. L.S. Goodman & Gilmore, 5. ed. Macmi//an, 7975. Stote, R. M., Smith, L. H., Wilson, M., Dube, R. S., Arnaud, C. D. Hydrochlorothiazide effects on serum calcium and immunoreact/ve parathyroid hormone concentrations: studies in normal subjects. Amm Intern. Med. 77:587, 7972.
2. Burg, M. Mechanisms of action ofdiuretic drugs. In The Kidney. Saunders, Philadelphia, 7976. p. 737.
3. Davies, D. L. Diuretics: mechanism of action and clinical application. Drugs, 1975.
4. Burg, Maurice ob. cit. 2.
5. Cabrera, J. Los diuréticos. Medicina Integral, 2.•373, 7981.
6. Lassiter, W.F. Disorders of sodium metabolism. In Strauss and Weft's diseases of the kidney, Little Brown, 1980. 67. Lassiter, Wi//iam E. ob. cit.
8. Maren, T. H. Carbonic anhydrase: chemistry, physiology, and inhibition. Physio/. Rev. 47:595, 1967.
9. Beyer, K. H., Baer, J. E., Michae/son, J. F., Russo, H. F. Renotropic characteristics of thacrynic acid: a phenoxyacetic sa/uretic-diuretic agent. J. Pharmaco/. Exp. Ther. 747:1, 7965.
10. Stein, J. H., Wilson, C. B., Kirkenda//, W. M. Differences in the acute effects of furosemide and etharcrynic acid in man. J. Lab. C/in. Med. 71:654, 1968.
11. Puschett, J. Be, Goldberg, M. The acute effects of furosemide on acid and electrolyte excretion in man. J. Lab. clin. Med. 77 :666, 1968.
12. De Torrente, A., Mi//er, P.D., Cronin, R. E., Rau/sen, P. E., Erickson, A. La, Schrier, R. W. Effects of furosemide and acetylcholine in norepinephrine-induced acute renal failure. Am. J. Physiol. 235:F737, 7978.
13. Burg, M. Furosemide effect on isolated perfused tubules. Am. J. Phisio/. 225:119, 1973.
14. Burg, M., Green, N. Effect of ethacrynic acid on the thick ascending limb of Hen/e's loop. Kidney /nt. 4.•301, 1973.
15. Edwards, B. R., Bear, P. G.i Sutton, R. A., Dirks, J. H. Micropuncture study of diuretic effects on sodium and calcium reabsorption in the dog nephron. J. c/in. Invest. 52:2418, 1973.
16. Eknoyam, G., Suki, W.N., Martinez-Maldonado, M. Effects of diuretics on urinary excretion of phosphate, calcium, and magnesium in thyroparathyroidectomized dogs. J. Lab. c/in. Med. 76:257, 1970.
17. Rocha, A. S., Maga/di, J. B., Kokko, J. P. Calcium and phosphate transport in isolated segments of rabbit Hen/e's loop. J. c/in. Invest. 59:975, 1977.
18. Suki, W.N., Rouse, D., Kokko, J.P. Calcium transport in the thick ascending limb (TA L) of Henle (abstract). Kidney Int. 72:467, 7977.
19. Suki, W. N., Yium, J. J., Von Mindem, M., Sa//er-Herbert, C., Ekncyan, G., Martinez-Maldonado, M. Acute treatment of hiperca/cemja with furosemide. N. Engl. J. Med. 283:836, 197b.
20. Rie//a, M. C. Principios de nefro/ogfa y disturbios hidroe/ectro/fticos. In Diuréticos. Guanabara Koogan, 7980.
21. Edwards, B. R. ob. cit.15
22. Lassiter, William, E. ob. cit. 6
23. Jorgensen, F. S., Brünner, S. The long-term effect of bendrof/umethjazide on renal calcium and magnesium excretion and stone formation in patients with recurring renal stones. Scand, J. Urol. Nephro/. 8:728, 1974.
24. Yendt, E. R., Guay, G. E, Garcia, D. A. The use of thiazides in the prevention of rena/ calcu/i. Can, Med. Assoc. J. 702:674, 7970.
25. Pak, C. Y. C. Hydrochlorothiazide therapy in nephro/ithiasis: effecy on the urinary activity product and formation product brushite. C/in. Pahrmaco/. Then 74.009, 1973. 26, Rocha, A. S. ob. cit.
27. Yendt, E. IR., Cohanim, M. Ten years' experience with the use of thiazides in the prevention of kidney stones. Trans. Am. clin Climatol. Assoc. 85: 65, 1973.
28, Popovtser, M. M., Subryan, V. L, Alfrey, A. C., Reeve, E. B., Schrier R. W. The acute effect of ch/orothiazide on serum-ionized calcium : evidence for a parathyriod hormone-dependent mechanism, J. clin. Invest. 55: 1295, 7975.
29. Pak, C. Y. c. ob. cit.25
30. Brickman, A. S., Massry, S. G, Coburn, J. W. Changes in serum and urinary calcium during treatment with hydrochlorothiazide; studies on mechanisms. J. c/in. Invest. 57:945, 1972.
31. Constanzo, L. S. On hypoca/cjuric action of ch/orothiazide. J. clin. Invest. 54:628, 1974,
32. Manitius, A., Silva, P., Epstein, F. H. Effect of hidroch/orothiazide on calcium excretion by the isolated perfused rat kidney. Proc. Soc. Exp. Biol. Med 760:760, 1979. 2033. Rie//a, M. C. ob. cit.
34. Goldberg, M. The renal physiology of diuretics. /n Handbook of physiology, section 8: renal physiology. American Physio/. Soc. Washington, D. C., 7973, p. 7003.
35. Kagawa, C., Sturtevant, F., Van Arman, C. Pharmacology of a new steroid that blocks salt activity of a/dosterone and desocycorticosterone. J. Pharmaco/. Exp. There 726:723, 7959.
36. Lidd/e, G. Specific and non-specific inhibition of minera/corticoid activity. Metabolism, 70:7021, 7967.
37. Sharp, G., Leaf, A. Effects of a/dosterone and its mechanism of action on sodium transport. In Handbook of physiology. Section 8: Rena/ physiol. Am. Physiol. Soc. Washington, D. C., 1973.
38. Benjamin, W., Singer, I. Aldosterone-induced protein in toad urinary bladder. Science, 786: 269, 1974.
39. Lessiter, Wi//iam, E. ob. cit. 6
40. Goldberg, M. ob. cit. 33
41. Baba, W., Tudhope, G., Wilson, G. Site and mechanism of action of the diuretic triamterene. C/in. Sci. 27:787, 7964.
42. Bear, J., Jones, C, Spitzer, S., Russo, H. The potassium-sparing and natriuretic activity of N-amidino-3, 5 diamino-6-chIoro pyraz/ne carboxamide hydrochloride dehydrate (ami/oride hydrochloride). J. Pharmacol. Exp. Ther, 757,472, 1967.
43. Wieb/ehaus, V., Weinstock, J., Maass, A., Brennon, F., Sosnowski, G. The diuretic and natriuretic activity of triamterene and severa/ related pteridine in the rat, J. Pharmaco/. Exp. Then 749:397, 1965.
44. Bear, J. ob. cit. 41
45. Berliner, Or/off, J. Carbonic anhydrase inhibitors. Pharmaco/. Rev. 8: 737, 7956.
46. Beyer, K., Bear, J, Physio/ogjca/ basis for the action of newer diuretic agents. Pharmaco/. Rev. 73.517, 7961.
47. Rie//a, M. C. 0b. cit?0 2048, Riel/a, M. C. ob. cit.
49. De Torrente, A. ob. cit. 12
50. Conway, J., Palmero, H. The vascular effect of the thiazjde diuretics. Arch. Intern. Med. 111,203, 1963.
51. Mudge, G. H. Diuretics and other agents employed in the mobilization of edema fluid. In the pharmacological basis of therapeutics. L.S. Goodman & Gilmore, 5. ed. Macmi//an, 7975. Stote, R. M., Smith, L. H., Wilson, M., Dube, R. S., Arnaud, C. D. Hydrochlorothiazide effects on serum calcium and immunoreact/ve parathyroid hormone concentrations: studies in normal subjects. Amm Intern. Med. 77:587, 7972.
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2017-06-28
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Santacruz C. Diuréticos: uso clínico racional. Rev Fac Cien Med (Quito) [Internet]. 28 de junio de 2017 [citado 4 de mayo de 2024];6(3-4):231-43. Disponible en: https://revistadigital.uce.edu.ec/index.php/CIENCIAS_MEDICAS/article/view/476
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