Splendiani G, Condò S
Dipartimento di Nefrologia e Dialisi, Policlinico Tor Vergata, Rome.
G Ital Nefrol. 2006 Jan-Feb;23 Suppl 34:S74-6.
Diuretic therapy is a drug therapy that increases urine volume, but not glomerular filtration rate (GFR). The diuretics act predominantly on tubular sites; the drugs that increase GRF are the aminophyllines, the positive inotropy or vasoactive substances that increase afferent arteriolar flux or intraglomerular pressure. We can divide the diuretics into six categories: 1) carbonic anhydrase inhibitors: acetazolamide, dichlorphenamide, methazolamide; 2) osmotic diuretics: glycerol, mannitol, urea; 3) loop diuretics: furosemide, bumetanide, ethacrynic acid, piretanide, torsemide; 4) thiazide and thiazide-like diuretics: chlorothiazide, trichlormethiazide, indapamide, chlorthalidone, metolazone; 5) potassium-sparers: a) kidney epithelial sodium channel inhibitors: amiloride and triamterene; b) aldosterone receptor antagonists: spironolactone, canrenoate potassium, eplerenone; 6) ADH antagonists: lithium salts, demeclocycline and ethanol. Diuretic therapy is useful in treating acute and chronic renal insufficiency, congestive heart failure, cirrhosis, overhydration and hypertension. Diuretic therapy increases urine volume, ion loss (except Na+, K+), and modifies diffusion (dilute urine) and convection mechanisms (reduced tubular absorption). Therefore, diuretics are very useful non-dangerous drugs.
利尿疗法是一种增加尿量但不增加肾小球滤过率（GFR）的药物疗法。利尿剂主要作用于肾小管部位；增加肾小球滤过率的药物是氨茶碱，即增加入球小动脉血流量或肾小球内压力的正性肌力药或血管活性物质。我们可将利尿剂分为六类：1）碳酸酐酶抑制剂：乙酰唑胺、双氯非那胺、甲醋唑胺；2）渗透性利尿剂：甘油、甘露醇、尿素；3）袢利尿剂：呋塞米、布美他尼、依他尼酸、吡咯他尼、托拉塞米；4）噻嗪类及类噻嗪类利尿剂：氯噻嗪、三氯噻嗪、吲达帕胺、氯噻酮、美托拉宗；5）保钾利尿剂：a）肾上皮钠通道抑制剂：阿米洛利和氨苯蝶啶；b）醛固酮受体拮抗剂：螺内酯、坎利酸钾、依普利酮；6）抗利尿激素拮抗剂：锂盐、地美环素和乙醇。利尿疗法在治疗急性和慢性肾功能不全、充血性心力衰竭、肝硬化、水过多和高血压方面很有用。利尿疗法增加尿量、离子丢失（钠、钾除外），并改变扩散（稀释尿液）和对流机制（减少肾小管重吸收）。因此，利尿剂是非常有用的非危险性药物。
