Diuretics in clinical practice. Part I: mechanisms of action, pharmacological effects and clinical indications of diuretic compounds

Abstract

Knowledge of the pharmacologic properties and mechanisms of action of diuretic agents is a prerequisite for the successful choice and effective clinical use of these compounds.

Chemical composition and diuretic, natriuretic and kaliuretic effects of extracts of Mimosa bimucronata (DC.) Kuntze leaves and its majority constituent methyl gallate in rats

“…The flow rate was 0.7 ml/min, with detection at 250 nm. The compounds were identified by comparing the retention time of samples to authentic standards of gallic acid (1) and MG (2). The extract and standards were dissolved in methanol and filtered through a Millipore â membrane (0.22 lm).…”

“…The chemical analysis with the fresh leaves of M. bimucronata permitted to isolate and identify the main constituent, MG, in addition gallic acid, present in low yield. The HPLC fingerprint of the MEMB leaves is represented in Figure 1, which indicates the presence of the compounds such as gallic acid (1) and MG (2). Other minor phenolic components were detected but were not identified.…”

“…In clinical practice, drugs that efficiently augment urinary output and electrolytes excretion are frequently used to treat cardiovascular and renal disorders, such as cardiac failure, hypertension, nephrotic syndrome and chronic kidney disease. [1,2] Although these agents, such as thiazide-type and loop diuretics, are effective in decreasing the probability of adverse cardiovascular outcomes, they are usually related with an extensive list of side effects, which include an increase in plasma levels of uric acid, a decline in the plasmatic potassium content, the presence of high levels of cholesterol in the blood and hyperglycaemia in people with diabetes. [3,4] Owing to the therapeutic importance of diuretic drugs for pathological conditions of fluid and electrolyte overload, the investigation for new options that are capable of increasing urinary volume excretion as well as electrolytes (particularly sodium) is extremely relevant.…”

Casein kinase 1α: biological mechanisms and theranostic potential

“…D4476 is the most effective and widely used inhibitor of CK1s, with an IC50 of 200–300 nM [ 216 ]. Triamterene—a drug approved by the Food and Drug Administration of the United States (FDA) for the treatment of edematous disorders such as cardiac failure, nephrotic syndrome, and hepatic cirrhosis [ 217 ]—was shown to induce epiblast stem cell reprogramming by inhibiting CK1α, with an IC50 of 33.5 μM. However, it also suppressed the kinase activity of CK1δ and CK1ε, with IC50 values of 6.9 and 30.4 μM, respectively [ 190 ].…”

Treating Hypertension in Diabetic Patients With Advanced Chronic Kidney Disease: What Should We Have in Mind?

“…For example, hydrochlorothiazide and thiazide-like diuretics are generally inactive in patients with eGFR <30 mL/min/1.73 m 2 and should be replaced by the more potent loop diuretics. 5 Further, although agents that block the renin-angiotensin-aldosterone system (RAAS) are recommended as first-line antihypertensive therapy in patients with diabetes, particularly when albuminuria is present, 6 it is not so rare in daily clinical practice to discontinue RAAS inhibitor use in patients with eGFR as low as 20 to 25 mL/min/1.73 m 2 ; this commonly occurs because of fear of acute renal injury and hyperkalemia that may result in the need for earlier initiation of hemodialysis in such patients. We encourage the authors to provide this valuable information either in their response to this letter or in a separate paper.…”