Diuretica

Diuretica, or diuretics, are drugs that increase urine production by altering renal handling of water and electrolytes. They act at different segments of the nephron, producing varying degrees of natriuresis and diuresis. Their primary use is to treat conditions associated with fluid overload and high blood pressure, including congestive heart failure, liver cirrhosis with edema or ascites, nephrotic syndrome, and hypertension. They may also be used to manage certain electrolyte disorders and, in some cases, to reduce intracranial or intraocular pressure.

Loop diuretics act on the thick ascending limb of the loop of Henle and inhibit the Na-K-2Cl cotransporter, yielding strong diuresis. They are effective for edema and acute heart failure but can cause potassium loss, dehydration, and, rarely, ototoxicity.

Thiazide diuretics inhibit the Na-Cl transporter in the distal tubule, producing moderate diuresis. They are commonly used for hypertension and mild edema but can lead to hyponatremia, hypokalemia, and metabolic changes.

Potassium-sparing diuretics include aldosterone antagonists (such as spironolactone and eplerenone) and sodium channel blockers (such as amiloride and triamterene). They reduce potassium loss, lowering the risk of hypokalemia, but can cause hyperkalemia and are often used in combination with other diuretics.

Carbonic anhydrase inhibitors (acetazolamide) are weaker diuretics used in specific settings, including glaucoma and altitude sickness. Osmotic diuretics (mannitol) increase tubular fluid osmolality and are used to reduce intracranial pressure or certain types of nephrotoxicity, with a risk of dehydration and electrolyte imbalance.

Common considerations include monitoring of blood pressure, kidney function, and electrolyte levels, as well as awareness of drug interactions and contraindications such as anuria or severe electrolyte disturbances.