Pathophysiology and Treatment of Hypertension and Oedema due to Renal Failure

Abstract

Hypertension and oedema resulting from sodium retention are the main indications for diuretic treatment in patients with chronic renal failure. The pharmacokinetics of most loop diuretics and their active metabolites are altered in chronic renal failure, due both to reduced transtubular transport via the proximal tubular anion transporter and to protein binding within the tubule. In chronic renal failure, the reduced number of nephrons leads to adaptive reduction of tubular sodium reabsorption, i.e. high baseline fractional natriuresis and increased absolute distal tubular sodium reabsorption. These processes interfere with the pharmacodynamic actions of diuretics. Therapeutic strategies to overcome the partial resistance to the action of diuretics in patients with chronic renal failure include the use of high doses, continuous administration and the combination of loop and thiazide compounds.

Loop diuretics: old and new ones — which one to choose in clinical practice? Experts’ Group Consensus endorsed by the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy and Working Group on Heart Failure

“…W nadciśnieniu tętniczym pierwotnym torasemid stosuje się u pacjentów ze zmniejszoną filtracją kłębuszkową (GFR < 30 ml/min/1,73 m 2 ) oraz u chorych z HF. Małe dawki torasemidu, ze względu na jego długi czas działania (12 h) i neutralność metaboliczną, mogą być stosowane jako leki pierwszego rzutu w terapii nadciśnienia tętniczego u pacjentów z nietolerancją glukozy, zaburzeniami lipidowymi, otyłością, zespołem metabolicznym, czyli u tych, u których istnieje zwiększone ryzyko rozwinięcia się cukrzycy [18].…”

B-Type Natriuretic Peptide Levels and Cardiac Dysfunction in Children on Peritoneal Dialysis

“…Patients with ESRD usually have short stature due to several factors, such as malnutrition, renal osteodystrophy, acidosis, or abnormalities in growth hormone levels (8). These patients may also show sodium and water retention, which results in edema and body weight increase (9). For example, edematous patients with malnutrition may have normal body mass index (BMI).…”