Sakalauskienė G, Civinskienė G, Antuševas A, Civinskas P
Lithuanian University of Health Sciences.
Kardiologiia. 2018 Jan(1):72-83. doi: 10.18087/cardio.2018.1.10084.
Edematous states caused by an excessesive extracellular fluid retention are major components of cardiovascular and renal disorders including chronic kidney disease, nephrotic syndrome, and heart failure. The use of diuretic drugs from various groups including loop duiretics are important means of pharmacological correction of these clinical conditions. Moreover, diuretics used to lower bood pressure as a part of antihypertensive treatment, reduce cardiovascular events. The response of patients to the dose of a diuretic is reflected by a sigmoid dose-response curve which can be affected by changes of sodium content in the body. Loop diuretics may fail to control salt and water retention despite the use of appropriate doses. The main reasons for loop diuretic resistance may be determined by further reduction of glomerular filtration rate and reduced peak concentration of loop diuretics in primary urine. Chronic treatment with loop diuretics can cause compensatory hyperthrophy of epithelial cells along the ascending limb of the loop of Henle and thus decrease of its diuretic effect. The principles of avoiding this phenomenon are the restriction of sodium intake, correction of doses, timing and frequency of drug administration, and use of combination diuretic therapy. Loop diuretic - related adverse events that involve uricaemia and ototoxicity also should be taken into consideration.
细胞外液潴留过多引起的水肿状态是心血管和肾脏疾病的主要组成部分，包括慢性肾脏病、肾病综合征和心力衰竭。使用包括袢利尿剂在内的各类利尿剂是对这些临床病症进行药物纠正的重要手段。此外，利尿剂作为降压治疗的一部分用于降低血压，可减少心血管事件。患者对利尿剂剂量的反应由一条S形剂量反应曲线反映，该曲线可能会受到体内钠含量变化的影响。尽管使用了适当剂量的袢利尿剂，仍可能无法控制盐和水的潴留。袢利尿剂抵抗的主要原因可能是肾小球滤过率进一步降低以及袢利尿剂在原尿中的峰值浓度降低。长期使用袢利尿剂可导致亨氏袢升支上皮细胞代偿性肥大，从而降低其利尿效果。避免这种现象的原则包括限制钠摄入、调整剂量、给药时间和频率以及采用联合利尿剂治疗。还应考虑与袢利尿剂相关的不良事件，包括尿毒症和耳毒性。
