Velázquez H, Wright F S
Annu Rev Pharmacol Toxicol. 1986;26:293-309. doi: 10.1146/annurev.pa.26.040186.001453.
This review has focused on the influence of several diuretic drugs on potassium handling by the kidney. One class of drugs (loop diuretics) acts by directly inhibiting a potassium absorptive mechanism in the luminal membrane of cells of the thick ascending limb of Henle's loop. Two other groups of diuretics affect potassium transport indirectly by inhibiting salt and water absorption upstream from the potassium secretory site in the late distal tubule: carbonic anhydrase inhibitors act in the proximal tubule; thiazides act in the early distal tubule. The subsequent increase in lumen flow rate then stimulates net potassium secretion by the distal tubule. A fourth class of drugs (spironolactone) acts by antagonizing the response of the distal tubule to aldosterone. These drugs decrease the ability of aldosterone to stimulate distal potassium secretion. Finally, a fifth group of drugs (potassium-sparing diuretics) decreases potassium secretion by increasing the luminal membrane voltage and thus decreasing the electrochemical gradient for potassium exit from the cell.
本综述聚焦于几种利尿药对肾脏钾代谢的影响。一类药物（袢利尿剂）通过直接抑制髓袢升支粗段细胞管腔膜上的钾吸收机制发挥作用。另外两组利尿剂通过抑制远曲小管晚期钾分泌部位上游的盐和水吸收间接影响钾转运：碳酸酐酶抑制剂作用于近端小管；噻嗪类作用于远曲小管早期。随后管腔流速增加进而刺激远曲小管的净钾分泌。第四类药物（螺内酯）通过拮抗远曲小管对醛固酮的反应发挥作用。这些药物降低醛固酮刺激远曲小管钾分泌的能力。最后，第五组药物（保钾利尿剂）通过增加管腔膜电压从而降低钾从细胞排出的电化学梯度来减少钾分泌。
