Krumlovsky F A, del Greco F
Postgrad Med. 1976 Apr;59(4):105-10. doi: 10.1080/00325481.1976.11714327.
Diuretics act primarily by blocking reabsorption of sodium at four major sites in the nephron. Clinically useful agents that block sodium reabsorption effectively in the proximal tubule are lacking. Furosemide (Lasix), ethacrynic acid (Edecrin), and possibly organomercurial agents are effective in the ascending limb of Henle's loop. Thiazides are the major agents acting in the early distal tubule. In the late distal tubule and collecting duct, spironolactone (Aldactone) and triamterene (Dyrenium) are useful, especially in combination with diuretics which act more proximally. In treating edematous states, initial therapy with thiazides is effective in most patients who do not exhibit moderate or severe renal insufficiency, severe hyperaldosteronism with excessive distal reabsorption of sodium in exchange for potassium, or excessive sodium reabsorption in the proximal tubule or ascending limb. Nonedematous states in which diuretic therapy is useful include hypertension, hypercalcemia, hypercalciuria, diabetes insipidus, and acute renal failure.
利尿剂主要通过阻断肾单位四个主要部位的钠重吸收起作用。目前缺乏能有效阻断近端小管钠重吸收的临床可用药物。呋塞米（速尿）、依他尼酸（利尿酸）以及可能的有机汞制剂在髓袢升支有效。噻嗪类是作用于远曲小管起始部的主要药物。在远曲小管末端和集合管，螺内酯（安体舒通）和氨苯蝶啶（三氨蝶呤）有用，尤其与作用部位更靠近近端的利尿剂联合使用时。在治疗水肿状态时，对于大多数没有中度或重度肾功能不全、不存在因严重醛固酮增多症导致远端钠重吸收过多以交换钾、或近端小管或髓袢升支钠重吸收过多的患者，初始使用噻嗪类治疗有效。利尿剂治疗有用的非水肿状态包括高血压、高钙血症、高钙尿症、尿崩症和急性肾衰竭。
