Influence of cardiac function on the diuretic and hemodynamic effects of the loop diuretic piretanide

Hasenfuß, Gerd; Holubarsch, C; Herzog, Charles A.; Knauf, H.; Just, Hanjörg; Spahn, H.; Mutschler, E.

doi:10.1002/clc.4960100203

Cited by 15 publications

(4 citation statements)

References 23 publications

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“…on the functional state of the kidney [8], Neither xipamide nor the combination of spironolac tone-furosemide was able to mobilize the as cites in patients in whom FENa was less than 0.2%. This dependency of diuretic response on FENa has also been demonstrated in pa tients with congestive heart failure [9], Regulation of renal sodium excretion in both cirrhotic ascites and congestive heart failure may have a common determinant, namely a reduced effective arterial blood vol ume [7,10,11 ] dictates the filling volume of the systemic arterial circulation. In heart failure reduction in cardiac output and increased systemic vas cular resistance are associated with a decrease in the effective arterial blood volume.…”

Section: Discussionmentioning

confidence: 99%

Liver Cirrhosis with Ascites: Pathogenesis of Resistance to Diuretics and Long-Term Efficacy and Safety of Torasemide

Knauf

Mutschler²

1994

Cardiology

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In a prospective randomized short-term study, the efficacy and safety of xipamide and a combination of spironolactone and furosemide were compared in the treatment of hepatic cirrhotic ascites. Twenty-two patients were randomized to either xipamide, 20 mg/day (group I), or spironolactone, 200 mg/day, combined with furosemide, 40 mg on alternate days (group II). During the first 4 days of treatment, adequate diuresis, measured as loss of body weight greater than 1.6 kg, occurred in 7 patients in group I and in 3 in group II. In the latter group, another 4 patients responded satisfactorily after a further 4 days of treatment. Four patients in group I who failed to respond to xipamide with an adequate loss of body weight were subsequently treated with the spironolactone-furosemide combination, but only one responded. Two patients in group II who failed to respond to the combination of spironolactone and furosemide also failed to respond to xipamide. In both groups, a positive diuretic response occurred only when the pretreatment fractional sodium excretion exceeded 0.2%. Diuretic resistance was overcome only by additional treatments which reduced proximal tubular sodium reabsorption. Xipamide commonly induced hypokalaemia; in contrast hyperkalaemia was seen following treatment with the spironolactone-furosemide combination. Renal function remained stable in all patients during both diuretic treatments. An open ongoing 6-month trial of torasemide, 10-40 mg/day, in combination with spironolactone, 50-400 mg/day, has also been undertaken in 117 patients with cirrhotic ascites who showed inadequate responses to salt and water restriction and spironolactone alone. Twenty-seven patients have been withdrawn from the study, 9 for the complications of hepatic coma, bleeding oesophageal varices, or hyponatraemia. Twenty-two patients are still being treated and 68 have completed the trial on a mean dose of torasemide, 15 mg/day. Body weight was reduced by a mean of 2.3 kg at 6 weeks, 2.6 kg at 14 weeks and 3.2 kg after 6 months. Loss of body weight was primarily associated with reduction of ascites and secondarily with reduction of peripheral oedema. There were no untoward adverse reactions with torasemide, and no significant changes in serum electrolytes, liver, renal, or haematological variables.

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Section: Discussionmentioning

confidence: 99%

Liver Cirrhosis with Ascites: Pathogenesis of Resistance to Diuretics and Long-Term Efficacy and Safety of Torasemide

Knauf

Mutschler²

1994

Cardiology

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“…Hierbei korreliert die verminderte fraktionelle Natriumausscheidung eng mit dem Grad der kardialen Funktionseinschränkung wie auch mit der zu erwartenden diuretischen Antwort [16]. Hierbei korreliert die verminderte fraktionelle Natriumausscheidung eng mit dem Grad der kardialen Funktionseinschränkung wie auch mit der zu erwartenden diuretischen Antwort [16].…”

Section: "Die Vermehrte Proximal Tubuläre Reabsorption Von Natrium Isunclassified

Aktuelle Diuretikatherapie

Heyne¹,

Veiel²,

Erley³

et al. 2000

Der Anaesthesist

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1038Der Evolution der Lebewesen aus dem Wasser heraus auf das Land hat ihnen neue Lebensräume eröffnet.Voraussetzung hierfür war es, den Körperzellen eine eigene wässrige Umgebung zu schaffen, den Extrazellularraum, der sie von äußeren Einflüssen unabhängig macht. Dies wurde möglich durch die Entwicklung der Niere von einem reinen Ausscheidungsorgan hin zu einer komplexen "Recyclinganlage", die das notwendige Wasser konserviert und den Extrazellularraum in Zusammensetzung und Volumen konstant hält.Für die Feinjustierung der Flüssigkeits-und Elektrolythomöostase ist die Niere in ein komplexes System von Regelkreisen eingebunden.Wie wichtig diese Funktion ist, wird nicht nur bei einem Versagen der Niere, sondern auch bei Störungen der neurohumoralen Regulation (Sympathikus, Renin-Angiotensin-Aldosteron-System) deutlich. Bereits die Retention von lediglich 150 ml pro Tag (etwa dem Volumen einer Tasse) führt klinisch innerhalb weniger Tage zum Auftreten von Atembeschwerden und peripheren Ödemen.

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“…Diuretic resistance can be predicted in clinical situations in which there is a low frac tional excretion of sodium, such as congestive heart failure ( fig. 8) [9] and hepatic cirrhosis with ascites [10]. These concepts may be ap plied with advantage to the prescription of diuretics in clinical practice (table 2, 3).…”

Section: Clinical Application Of the Concept Of Intrinsic Diuretic Acmentioning

confidence: 99%

“…8. Dependence of diuretic-induced diuresis (piretanide, 6 mg intravenously) on pretreatment frac tional sodium excretion in patients with congestive heart failure (glomerular filtration rate >90 ml/min) [9]. Sign Reason Cause Presentation Therapy the fractional excretion of sodium until a maximum of 25% is achieved, as is the case in end-stage renal failure.…”

Section: Clinical Application Of the Concept Of Intrinsic Diuretic Acmentioning

confidence: 99%

Functional State of the Nephron and Diuretic Dose-Response - Rationale for Low-Dose Combination Therapy

Knauf

Mutschler²

1994

Cardiology

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The functions of the different nephron segments follow changes in the effective arterial blood volume and the extracellular fluid volume. In syndromes with reduced effective arterial blood volume, for example congestive heart failure, decompensated hepatic cirrhosis and nephrotic syndrome, hyperreabsorption of sodium in the proximal tubule reduces the sodium load in the more distal segments of the nephron. As this is a major site of sodium excretion, reduction in the response to a diuretic may be predicted by a reduced fractional excretion of sodium ( < 0.2%). Such diuretic resistance may be overcome with acetazolamide, which increases delivery of sodium to the distal tubule. In syndromes with increased extracellular fluid volume, such as chronic renal failure, distal tubular rejection of sodium leads to a progressive increase in its fractional excretion as the glomerular filtration rate is reduced. The remaining intact nephrons exhibit a relatively increased response to diuretics. The efficacy of loop diuretics in renal failure can be optimized by combination with thiazides. The latter prevent early distal tubular hyperreabsorption following diuretic-induced blockade of sodium transport in the loop of Henle. For these reasons, low-dose combinations of different diuretics induce ‘segmental nephron blockade’ and are, therefore, potentially more clinically effective and safer than high doses of single compounds.

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Influence of cardiac function on the diuretic and hemodynamic effects of the loop diuretic piretanide

Cited by 15 publications

References 23 publications

Liver Cirrhosis with Ascites: Pathogenesis of Resistance to Diuretics and Long-Term Efficacy and Safety of Torasemide

Liver Cirrhosis with Ascites: Pathogenesis of Resistance to Diuretics and Long-Term Efficacy and Safety of Torasemide

Aktuelle Diuretikatherapie

Functional State of the Nephron and Diuretic Dose-Response - Rationale for Low-Dose Combination Therapy

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