Russo D, Memoli B, Andreucci V E
Department of Nephrology, Second Faculty of Medicine, University of Naples, Italy.
Clin Nephrol. 1992;38 Suppl 1:S69-73.
Loop diuretics (furosemide, bumetanide, muzolimine, piretamide, torasemide) are powerful drugs capable of increasing sodium excretion and urine output even when renal function is markedly impaired. In patients with chronic renal failure (CRF), loop diuretics may be given to control extracellular volume (ECV) expansion responsible for hypertension. But the use of loop diuretics in chronic uremia is mostly helpful when impaired renal function co-exists with nephrotic syndrome or chronic heart failure. Due to their powerful natriuretic activity, loop diuretics have been administered also to patients on maintenance dialysis to reduce the frequency of and/or to curtail dialysis time. In this condition, however, the increase of sodium and water excretion is very limited; whereas the use of diuretics in high dosage is not devoid of risky side effects such as neurologic lesions, cramps, deafness, weakness, muscle pain. In some patients with oliguric form of acute renal failure (ARF), loop diuretics increase sodium excretion and urine output. They do not affect the mortality rate for ARF but may facilitate the treatment of patients by reverting an oliguric form to a non-oliguric form of ARF.
袢利尿剂（呋塞米、布美他尼、莫唑胺、吡咯他尼、托拉塞米）是强效药物，即使在肾功能明显受损时也能增加钠排泄和尿量。在慢性肾衰竭（CRF）患者中，可使用袢利尿剂来控制导致高血压的细胞外液量（ECV）扩张。但在慢性尿毒症中，当肾功能受损与肾病综合征或慢性心力衰竭并存时，使用袢利尿剂大多有益。由于其强大的利钠活性，袢利尿剂也已用于维持性透析患者，以减少透析频率和/或缩短透析时间。然而，在这种情况下，钠和水排泄的增加非常有限；而高剂量使用利尿剂并非没有风险的副作用，如神经病变、痉挛、耳聋、虚弱、肌肉疼痛。在一些少尿型急性肾衰竭（ARF）患者中，袢利尿剂可增加钠排泄和尿量。它们不影响ARF的死亡率，但可通过将少尿型ARF转变为非少尿型ARF来促进患者的治疗。
