Renu Dwivedi,
Avi Baliyan,
- Assistant Professor, School of Pharmaceutical Sciences, Bahra University, Waknaghat, Himachal Pradesh, India
- Student, School of Pharmaceutical Sciences, Bahra University, Waknaghat, Himachal Pradesh, India
Abstract
Diuretics have a rich history that spans several centuries, and this review aims to highlight their progression and clinical uses. We start by exploring kidney physiology, followed by a description of how diuretics function through symporters in the renal tubules. Different categories of diuretics are outlined, along with details of their specific actions. Next, we investigate the clinical use of diuretics in conditions, such as congestive heart failure and hypertension, as well as in some less prevalent but medically important conditions. The possible side effects of diuretics, along with their underlying causes, are also addressed. Frequent adverse effects, including hypokalemia and hyponatremia, are examined in depth, along with other electrolyte disturbances like hypomagnesemia. The role of diuretics in the management of chronic kidney disease is explored, along with updates on new guidelines in this field. A segment on diuretic misuse is included, given its growing recognition in clinical settings, emphasizing the often-tragic consequences of such abuse. Additionally, research is ongoing into the use of diuretics for diagnosing certain types of tubular renal acidosis. Lastly, some of the latest strategies for diuretic treatment are discussed, often stemming from advances in molecular biology, revealing new compounds that may soon enter future medication lists.
Keywords: Diuretics, Urine concentration, Thiazide diuretics, Potassium sparing, hydrochlorothiazide.
[This article belongs to Research and Reviews: A Journal of Pharmacology ]
Renu Dwivedi, Avi Baliyan. The Function of Diuretics in Current Medical Practice and Prospective Advancements. Research and Reviews: A Journal of Pharmacology. 2025; 15(01):70-75.
Renu Dwivedi, Avi Baliyan. The Function of Diuretics in Current Medical Practice and Prospective Advancements. Research and Reviews: A Journal of Pharmacology. 2025; 15(01):70-75. Available from: https://journals.stmjournals.com/rrjop/article=2025/view=208604
References
- Wile Diuretics: A review. Ann Clin Biochem. 2012;49(5):419–31 https://doi.org/10.1258/acb.2011.011281.
- Supuran CT, Scozzafava A. Carbonic-anhydrase inhibitors and their therapeutic potential. Expert Opin Ther Pat. 2000;10(5):575–600. https://doi.org/10.1517/13543776.10.5.575.
- Greenberg Diuretic complications. Am J Med Sci. 2000;319(1):10–24. https://doi.org/10.1016/S0002–9629(15)40676–7.
- Zhuo JL, Li Proximal nephron. Compr Physiol. 2013;3(3):1079–123. https://doi.org/10.1002/cphy.c110061.
- Agre P, Preston GM, Smith BL, Jung JS, Raina S, Moon C, et al. Aquaporin CHIP: The archetypal molecular water channel. Am J Physiol Renal Physiol. 1993;265(4):F463–76. https://doi.org/10.1152/ajprenal.1993.265.4.f463.
- Beger RD, Sun J, Schnackenberg LK. Metabolomics approaches for discovering biomarkers of drug-induced hepatotoxicity and nephrotoxicity. Toxicol Appl Pharmacol. 2010;243(2):154–66. https://doi.org/10.1016/j.taap.2009.11.019.
- Knepper M, Burg M. Organization of nephron function. Am J Physiol Renal Physiol. 1983;244(6):F579–89. https://doi.org/10.1152/ajprenal.1983.244.6.f579.
- Bell R, Mandalia Diuretics and the kidney. BJA Educ. 2022;22(6):216–23. https://doi.org/10.1016/j.bjae.2022.02.003.
- Brater DC. Pharmacology of diuretics. Am J Med Sci. 2000;319(1):38–50. https://doi.org/10.1016/S0002-9629(15)40678-0.
- Dyckner T, Wmr P. Potassium-sparing diuretics. 1:79–83.
- Ellison DH, Felker GM. Diuretic treatment in heart failure. N Engl J Med. 2017;377(20):1964– https://doi.org/10.1056/nejmra1703100.
- Krämer BK, Schweda F, Riegger GAJ. Diuretic treatment and diuretic resistance in heart failure. Am J Med. 1999;106(1):90–6. https://doi.org/10.1016/S0002–9343(98)00365–9.
- Epstein M, Calhoun DA. Aldosterone blockers (mineralocorticoid receptor antagonism) and potassium-sparing diuretics. J Clin Hypertens. 2011;13(9):644–8. https://doi.org/10.1111/j.17512011.00511.x.
- Faris R, Flather M, Purcell H, Henein M, Poole-Wilson P, Coats A. Current evidence supporting the role of diuretics in heart failure: A meta-analysis of randomised controlled trials. Int J Cardiol. 2002;82(2):149–58. https://doi.org/10.1016/S0167–5273(01)00600–3.
- Gade W, Robinson B. A brief survey of aquaporins and their implications for renal physiology. Clin Lab Sci. 2006;19(2):70–9.
- Wittner M, Di Stefano A, Wangemann P, Greger R. How do loop diuretics act? Drugs. 1991;41(Suppl 3):1–13. https://doi.org/10.2165/00003495–199100413–
- Macías-Núñez JF, López-Novoa JM. Physiology of the healthy aging kidney. In: The Aging Kidney in Health and Disease. Springer; 2007. pp. 93–112. https://doi.org/10.1007/978–0–38772659–
- Nielsen S, Smith BL, Christensen EI, Agre P. Distribution of the aquaporin CHIP in secretory and resorptive epithelia and capillary endothelia. Proc Natl Acad Sci U S A. 1993;90(15):7275–9. https://doi.org/10.1073/pnas.90.15.7275.
- Pashley S, Wallace MA. Anatomy and physiology of the kidney. AORN J. 1998;68(5):799–820.
- Qavi AH, Kamal R, Schrier RW. Clinical use of diuretics in heart failure, cirrhosis, and nephrotic syndrome. Int J Nephrol. 2015;2015:975934. https://doi.org/10.1155/2015/975934.
- Yool AJ, Migliati ER, Creek Q, Ritter LS, Data RUSA. United States Patent. 2011;2(12).
- Shah S, Khatri I, Freis ED. Mechanism of antihypertensive effect of thiazide diuretics. Am Heart1978;95(5):611–8. https://doi.org/10.1016/0002–8703(78)90303–4.
- Salvetti A, Ghiadoni L. Thiazide diuretics in the treatment of hypertension: An update. J Am Soc Nephrol. 2006;17(Suppl 2):25–9. https://doi.org/10.1681/ASN.2005121329.
- Supuran CT. How many carbonic anhydrase inhibition mechanisms exist? J Enzyme Inhib Med Chem. 2016;31(3):345–60. https://doi.org/10.3109/14756366.2015.1122001.
- van Zwieten PA. Comparative mechanisms of action of diuretic drugs in hypertension. Eur Heart
- Schrier RW. Use of diuretics in heart failure and cirrhosis. Semin Nephrol. 2011;31(6):503–12. https://doi.org/10.1016/j.semnephrol.2011.09.005.
- 1992;13(Suppl G):2–4. https://doi.org/10.1093/eurheartj/13.suppl_G.2Schoofs MWCJ, Van Der Klift M, Hofman A, De Laet CEDH, Herings RMC, Stijnen T, et al. Thiazide diuretics and the risk for hip fracture. Ann Intern Med. 2003;139(6):476–82. https://doi.org/10.7326/0003–4819–139–6–200309160–00010.
- Roush GC, Ernst ME, Kostis JB, Yeasmin S, Sica DA. Dose doubling, relative potency, and dose equivalence of potassium-sparing diuretics affecting blood pressure and serum potassium: Systematic review and meta-analyses. J 2016;34(1):11–9.
- Titko T, Perekhoda L, Drapak I, Tsapko Y. Modern trends in diuretics development. Eur J Med Chem. 2020;208:112855. https://doi.org/10.1016/j.ejmech.2020.112855.
- Verkman AS. Novel roles of aquaporins revealed by phenotype analysis of knockout mice. Rev Physiol Biochem Pharmacol. 2005;155:31–55. https://doi.org/10.1007/s10254–005–0040–

Research and Reviews: A Journal of Pharmacology
| Volume | 15 |
| Issue | 01 |
| Received | 18/02/2025 |
| Accepted | 10/03/2025 |
| Published | 23/04/2025 |
| Publication Time | 64 Days |
Login
PlumX Metrics