Drugs

, Volume 22, Issue 6, pp 477–494 | Cite as

Resistance to Diuretics

Emphasis on a Pharmacological Perspective
  • D. Craig Brater
Review Articles

Summary

Resistance to diuretics occurs frequently in clinical settings. Most attention to this phenomenon has been directed toward the pathophysiology of the disease state, with little focus on the pharmacology of the diuretics themselves. This review summarises the pathogenesis and emphasises the pharmacological determinants of response to diuretics, including absorption, delivery to the kidney, and response to amounts of diuretic reaching the site of action.

In normal subjects, overall response to organic acid diuretics such as frusemide (furosemide) is determined by the total amount of drug delivered into the urine (reflecting amounts of drug reaching the intraluminal site of action), the time course of delivery, and the relationship between amounts of drug reaching the urine and response (the dynamics of response). The conditions of azotaemia, inhibition of synthesis of prostaglandins, and the oedematous disorders of congestive heart failure, cirrhotic liver disease and nephrotic syndrome are examined in the above context.

In azotaemic subjects, delivery of organic acid diuretics to their intraluminal site of action is inhibited by accumulated endogenous organic acids which compete for transport into the nephron at the organic acid secretory site of the proximal tubule. Whether the dynamics of response are changed has not been investigated. During inhibition of synthesis of prostaglandins, and in the oedematous disorders, there appear to be no changes in handling of frusemide; i.e. bioavailability, total drug delivered into the urine and the time course of delivery are comparable with that in normal subjects unless concomitant renal dysfunction exists. Resistance in these conditions is therefore due to a change in the dynamics of response.

Keywords

Indomethacin Aldosterone Furosemide Proximal Tubule Renal Blood Flow 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abe, K.; Irokawa, N.; Yasujima, M.; Seino, M.; Chiba, S.; Sakurai, Y.; Yoshinaga, K. and Saito, T.: The kallikrein-kinin system and prostaglandins in the kidney. Their relation to furosemide-induced diuresis and to the renin-angiotensin-aldosterone system in man. Circulation Research 43: 254–260 (1978)PubMedGoogle Scholar
  2. Abe, K.; Yasujima, M.; Chiba, S.; Irokawa, N.; Ito, T. and Yoshinaga, K.: Effect of furosemide on urinary excretion of prostaglandin E in normal volunteers and patients with essential hypertension. Prostaglandins 14: 513–521 (1977)PubMedGoogle Scholar
  3. Anderson, R.J.; Cadnapaphornchai, P.; Harbottle, J.A.; McDonald, K.M. and Schrier, R.W.: Mechanism of effect of thoracic inferior vena cava constriction on renal water excretion. Journal of Clinical Investigation 54: 1473–1479 (1974)PubMedGoogle Scholar
  4. Anderson, R.J.; Cronin, R.E.; McDonald, K.M. and Schrier, R.W.: Mechanisms of portal hypertension-induced alterations in renal hemodynamics, renal water excretion, and renin secretion. Journal of Clinical Investigation 58: 964–970 (1976)PubMedGoogle Scholar
  5. Auld, R.B.; Alexander, E.A. and Levinsky, N.G.: Proximal tubular function in dogs with thoracic caval constriction. Journal of Clinical Investigation 50: 2150–2158 (1971)PubMedGoogle Scholar
  6. Bailie, M.D.; Barbour, J.A. and Hook, J.B.: Effects of indomethacin on furosemide-induced changes in renal blood flow. Proceedings of the Society for Experimental Biology and Medicine 148: 1173–1176 (1975)PubMedGoogle Scholar
  7. Baldus, W.P.; Summerskill, W.H.J.; Hunt, J.C. and Maher, F.T.: Renal circulation in cirrhosis: Observations based on catheterization of the renal vein. Journal of Clinical Investigation 43: 1090–1097 (1964)PubMedGoogle Scholar
  8. Bank, N. and Aynedjian, H.S.: A micropuncture study of renal salt and water retention in chronic bile duct obstruction. Journal of Clinical Investigation 55: 994–1002 (1975)PubMedGoogle Scholar
  9. Barger, A.C.: Renal hemodynamic factors in congestive heart failure. Annals of the New York Academy of Science 139: 276–284 (1966)Google Scholar
  10. Bell, N.H.; Schedl, H.P. and Bartter, F.C.: An explanation for abnormal water retention and hypo-osmolality in congestive heart failure. American Journal of Medicine 36: 351–360 (1964)PubMedGoogle Scholar
  11. Bennett, W.M.; Bagby, G.C.; Autonovic, J.N. and Porter, G.A.: Influence of volume expansion on proximal tubular sodium reabsorption in congestive heart failure. American Heart Journal 85: 55–64 (1973)PubMedGoogle Scholar
  12. Berg, K.J. and Loew, D.: Inhibition of furosemide-induced natriuresis by acetylsalicylic acid in dogs. Scandinavian Journal of Clinical Laboratory Investigation 37: 125–131 (1977)Google Scholar
  13. Beyer, K.H.: The mechanism of action of chlorothiazide. Annals of the New York Academy of Science 71: 363–379 (1958)Google Scholar
  14. Beyer, K.H. and Baer, J.E.: The site and mode of action of some sulfonamide-derived diuretics. Medical Clinics of North America 58: 735–750 (1975)Google Scholar
  15. Birtch, A.G.; Zakheim, R.M.; Jones, L.G. and Barger, A.C.: Redistribution of renal blood flow produced by furosemide and ethacrynic acid. Circulation Research 21: 869–878 (1967)PubMedGoogle Scholar
  16. Bourland, W.A.; Day, D.K. and Williamson, H.E.: The role of the kidney in the early nondiuretic action of furosemide to reduce elevated left atrial pressure in the hypervolemic dog. Journal of Pharmacology and Experimental Therapeutics 202: 221–229 (1977)PubMedGoogle Scholar
  17. Brater, D.C.: Analysis of the effect of indomethacin on the response to furosemide in man. Effect of dose of furosemide. Journal of Pharmacology and Experimental Therapeutics 210: 386–390 (1979)PubMedGoogle Scholar
  18. Brater, D.C.: Effects of probenecid on furosemide response. Clinical Pharmacology and Therapeutics 23: 259–265 (1978)aPubMedGoogle Scholar
  19. Brater, D.C.: Increase in diuretic effects of chlorothiazide by probenecid. Clinical Pharmacology and Therapeutics 23: 259–265 (1978)bPubMedGoogle Scholar
  20. Brater, D.C.; Beck, J.M.; Adams, B.V. and Campbell, W.B.: Effects of indomethacin on furosemide-stimulated urinary PGE2 excretion in man. European Journal of Pharmacology 65: 213–219 (1980)aPubMedGoogle Scholar
  21. Brater, D.C.; Chennavasin, P. and Seiwell, R.: Furosemide in patients with heart failure. Shift of the dose-response relationship. Clinical Pharmacology and Therapeutics 28: 182–186 (1980)bPubMedGoogle Scholar
  22. Brenner, B.M. and Stein, J.H.: Sodium and Water Homeostasis: Contemporary Issues in Nephrology, Vol. 1 (Churchill Livingstone, New York, Edinburgh and London 1978)Google Scholar
  23. Brenner, B.M. and Troy, J.L.: Postglomerular vascular protein concentration: Evidence for a causal role in governing fluid reabsorption and glomerulotubular balance by the renal proximal tubule. Journal of Clinical Investigation 50: 336–349 (1971)PubMedGoogle Scholar
  24. Brenner, B.M.; Falchuk, K.H.; Kiemowitz, R.I. and Berliner, R.W.: The relationship between peritubular capillary protein concentration and fluid reabsorption by the renal proximal tubule. Journal of Clinical Investigation 48: 1519–1531 (1969)PubMedGoogle Scholar
  25. Brown, J.J.; Davies, D.L.; Johnson, N.W.; Lever, F. and Robertson, J.I.S.: Renin relationships in congestive cardiac failure, treated and untreated. American Heart Journal 80: 329–342 (1970)PubMedGoogle Scholar
  26. Burg, M.B.: Tubular chloride transport and the mode of action of some diuretics. Kidney International 9: 189–197 (1976)PubMedGoogle Scholar
  27. Burke, T.J.; Robinson, R.R. and Clapp, J.R.: Determinants of the effect of furosemide on the proximal tubule. Kidney International 1: 12–18 (1972)PubMedGoogle Scholar
  28. Cannon, P.J.: The kidney in heart failure. New England Journal of Medicine 296: 26–32 (1977)PubMedGoogle Scholar
  29. Chaimovitz, C; Szylman, P.; Alroy, G. and Better, O.S.: Mechanism of increased renal tubular sodium reabsorption in cirrhosis. American Journal of Medicine 52: 198–202 (1972)PubMedGoogle Scholar
  30. Chennavasin, P.; Seiwell, R. and Brater, D.C.: Pharmacokineticdynamic analysis of the indomethacin-furosemide interaction in man. Journal of Pharmacology and Experimental Therapeutics 215: 77–81 (1980)PubMedGoogle Scholar
  31. Chennavasin, P.; Seiwell, R.; Brater, D.C. and Liang, W.M.M.: Pharmacodynamic analysis of the furosemide-probenecid interaction in man. Kidney International 16: 187–195 (1979)PubMedGoogle Scholar
  32. Chonko, A.M.; Bay, W.H.; Stein, J.H. and Ferris, T.F.: The role of renin and aldosterone in the salt retention of edema. American Journal of Medicine 63: 881–889 (1977)PubMedGoogle Scholar
  33. Cirksena, W.J.; Dirks, J.H. and Berliner, R.W.: Effect of thoracic cava obstruction on response of proximal tubule sodium reabsorption to saline infusion. Journal of Clinical Investigation 45: 179–186 (1966)PubMedGoogle Scholar
  34. Coppage, W.S.; Island, D.P.; Cooner, A.E. and Liddle, G.W.: The metabolism of aldosterone in normal subjects and in patients with hepatic cirrhosis. Journal of Clinical Investigation 41: 1672–1680 (1962)PubMedGoogle Scholar
  35. Data, J.L.; Rane, A.; Gerkens, J.; Wilkinson, G.R.; Nies, A.S. and Branch, R.A.: The influence of indomethacin on the pharmacokinetics, diuretic response and hemodynamics of furosemide in the dog. Journal of Pharmacology and Experimental Therapeutics 206: 431–438 (1978)PubMedGoogle Scholar
  36. Davis, J.O.; Pechet, M.M.; Ball, W.C. and Goodkind, M.J.: Increased aldosterone secretion in dogs with right-sided congestive heart failure and in dogs with thoracic inferior vena cava constriction. Journal of Clinical Investigation 36: 689–694 (1957)PubMedGoogle Scholar
  37. Deen, W.M.; Robertson, C.R. and Brenner, B.M.: Glomerular ultrafiltration. Federation Proceedings 33: 14–20 (1974)PubMedGoogle Scholar
  38. DeWardener, H.E.: The control of sodium excretion. American Journal of Physiology 235: F163-F173 (1978)Google Scholar
  39. Dikshit, K.; Vyden, J.K.; Forrester, J.S.; Chatterjee, K.; Prakash, R. and Swan, H.J.C.: Renal and extrarenal hemodynamic effects of furosemide in congestive heart failure after acute myocardial infarction. New England Journal of Medicine 288: 1087–1090 (1973)PubMedGoogle Scholar
  40. Dirks, J.H.; Cirksena, W.J. and Berliner, R.W.: The effect of saline infusion on sodium reabsorption by the proximal tubule of the dog. Journal of Clinical Investigation 44: 1160–1170 (1965)PubMedGoogle Scholar
  41. Earley, L.E. and Friedler, R.M.: Studies on the mechanism of natriuresis accompanying increased renal blood flow and its role in the renal response to extra-cellular volume expansion. Journal of Clinical Investigation 44: 1857–1865 (1965)PubMedGoogle Scholar
  42. Earley, L.E. and Martino, J.A.: Influence of sodium balance on the ability of diuretics to inhibit tubular reabsorption. A study of factors that influence renal tubular sodium reabsorption in man. Circulation 42: 323–334 (1970)PubMedGoogle Scholar
  43. Earley, L.E.; Martino, J.A. and Friedler, R.M.: Factors affecting sodium reabsorption by proximal tubule as determined during blockade of distal sodium reabsorption. Journal of Clinical Investigation 45: 1678–1684 (1966)Google Scholar
  44. Eisenbach, G.M.; Weise, M. and Stolte, H.: Amino acid reabsorption in the rat nephron. Free flow micropuncture study. European Journal of Physiology 357: 63–76 (1975)PubMedGoogle Scholar
  45. Epstein, M.: Deranged sodium homeostasis in cirrhosis. Gastroenterology 76: 622–635 (1979)aPubMedGoogle Scholar
  46. Epstein, M.: Renal sodium handling in cirrhosis: A reappraisal. Nephron 23: 211–217 (1979)bPubMedGoogle Scholar
  47. Epstein, M.: The Kidney in Liver Disease (Elsevier-North Holland, New York 1978)Google Scholar
  48. Epstein, M.; Berk, D.P.; Hollenberg, N.K.; Adams, D.F.; Chalmers, T.C.; Abrams, H.L. and Merrill, J.P.: Renal failure in the patient with cirrhosis. The role of vasoconstriction. American Journal of Medicine 49: 175–185 (1970)PubMedGoogle Scholar
  49. Epstein, M.; Hollenberg, N.K.; Guttmann, R.D.; Conroy, M.; Basch, R.I. and Merrill, J.P.: Effect of ethacrynic acid and chlorothiazide on intrarenal hemodynamics in normal man. American Journal of Physiology 220: 482–487 (1971)PubMedGoogle Scholar
  50. Epstein, M.; Levinson, R.; Sancho, J.; Haber, E. and Re, R.: Characterization of the renin-aldosterone system in decompensated cirrhosis. Circulation Research 41: 818–829 (1977)PubMedGoogle Scholar
  51. Epstein, M.; Pins, D.S; Schneider, N. and Levinson, R.: Determinants of deranged sodium and water homeostasis in decompensated cirrhosis. Journal of Laboratory and Clinical Medicine 87: 822–839 (1976)PubMedGoogle Scholar
  52. Frazier, H.S. and Yager, H.: The clinical use of diuretics: Renal regulation of salt and water balances. New England Journal of Medicine 288: 246–257(1973)PubMedGoogle Scholar
  53. Friedler, R.M.; Bellau, L.J.; Martino, J.A. and Earley, L.E.: Hemodynamically induced natriuresis in the presence of sodium retention resulting from constriction of the thoracic inferior vena cava. Journal of Laboratory and Clinical Medicine 69: 565–583 (1967)PubMedGoogle Scholar
  54. Friedman, Z.; Demers, L.M.; Marks, K.H.; Uhrmann, S. and Maisels, M.J.: Urinary excretion of prostaglandin E following the administration of furosemide and indomethacin to sick low-birth-weight infants. Journal of Pediatrics 93: 512–515 (1978)PubMedGoogle Scholar
  55. Frohnert, P.P.; Hohmann, B.; Zwiebel, R. and Baumann, K.: Free flow micropuncture studies of glucose transport in the rat nephron. European Journal of Physiology 315: 66–85 (1970)PubMedGoogle Scholar
  56. Genest, J.; Granger, P.; DeChamplain, J. and Boucher, R.: Endocrine factors in congestive heart failure. American Journal of Cardiology 22: 35–42 (1968)PubMedGoogle Scholar
  57. Gerber, J.G. and Nies, A.S.: Furosemide-induced renal vasodilation: The role of the release of arachidonic acid. Advances in Prostaglandin Thromboxane Research 7: 1079–1082 (1980)Google Scholar
  58. Gibson, D.G.; Marshall, J.C. and Lockey, E.: Assessment of proximal tubule sodium reabsorption during water diuresis in patients with heart disease. British Heart Journal 32: 399–405 (1970)PubMedGoogle Scholar
  59. Goodyer, A.V.N.; Relman, A.S.; Lawrason, F.D. and Epstein, F.H.: Salt retention in cirrhosis of the liver. Journal of Clinical Investigation 29: 973–981 (1950)PubMedGoogle Scholar
  60. Gross, J.B. and Kokko, J.P.: Effects of aldosterone and potassium-sparing diuretics on electrical potential differences across the distal nephron. Journal of Clinical Investigation 59: 82–89 (1977)PubMedGoogle Scholar
  61. Hamilton, W.F.; Ellison, R.G.; Pickering, R.W.; Hauge, E.E. and Rucker, J.T.: Hemodynamic and endocrine responses to experimental mitral stenosis. American Journal of Physiology 176: 445–451 (1954)PubMedGoogle Scholar
  62. Humes, H.D.; Gottlieb, M.N. and Brenner, B.M.: The kidney in congestive heart failure; in Brenner and Stein (Eds) Sodium and Water Homeostasis, pp.51–72 (Churchill Livingstone, New York 1978)Google Scholar
  63. Jacobson, H.R. and Kokko, J.P.: Diuretics: Sites and mechanisms of action. Annual Review of Pharmacology and Toxicology 16: 201–214 (1976)PubMedGoogle Scholar
  64. Jones, W.A.; Rao, D.R.G. and Braunstein, H.: The renal glomerulus in cirrhosis of the liver. American Journal of Pathology 39: 393–404 (1961)PubMedGoogle Scholar
  65. Kaloyanides, G.J.; Cacciaguida, R.J.; Pablo, N.C. and Porush, J.G.: Increased sodium reabsorption in the proximal and distal tubule of caval dogs. Journal of Clinical Investigation 49: 1543–1551 (1969)Google Scholar
  66. Kilcoyne, M.M.; Schmidt, D.H. and Cannon, P.J.: Intrarenal blood flow in congestive heart failure. Circulation 47: 786–797 (1973)PubMedGoogle Scholar
  67. Kinney, M.J.; Schneider, A.; Wapnick, S.; Grosberg, S. and LeVeen, H.: The ‘hepatorenal’ syndrome and refractory ascites. Successful therapy with the LeVeen-type peritoneal-venous shunt and valve. Nephron 23: 228–232 (1979)PubMedGoogle Scholar
  68. Kirkendall, W.M. and Stein, J.H.: Clinical pharmacology of furosemide and ethacrynic acid. American Journal of Cardiology 22: 162–167 (1968)PubMedGoogle Scholar
  69. Klinger, E.L.; Vaamonde, C.A.; Vaamonde, L.S.; Lancestremer, R.G.; Morosi, H.J.; Frisch, E. and Papper, S.: Renal function changes in cirrhosis of the liver. Archives of Internal Medicine 125: 1010–1015 (1970)Google Scholar
  70. Knochel, J.P. and White, M.G.: The role of aldosterone in renal physiology. Archives of Internal Medicine 131: 876–884 (1973)PubMedGoogle Scholar
  71. Knox, F.G.; Wright, F.S.; Howards, S.S. and Berliner, R.W.: Effect of furosemide on sodium reabsorption by proximal tubule of the dog. American Journal of Physiology 217: 192–198 (1969)PubMedGoogle Scholar
  72. Kokko, J.P.: Membrane characteristics governing salt and water transport in the loop of Henle. Federation Proceedings 33: 25–30 (1974)PubMedGoogle Scholar
  73. Kover, G. and Tost, H.: The effect of indomethacin on kidney function: Indomethacin and furosemide antagonism. European Journal of Physiology 372: 215–220 (1977)PubMedGoogle Scholar
  74. Kunau, R.T.; Weiler, DR. and Webb, H.L.: Clarification of the site of action of chlorothiazide in the rat nephron. Journal of Clinical Investigation 56: 401–407 (1975)PubMedGoogle Scholar
  75. Kuroda, S.; Aynedjian, H.S. and Bank, N.: A micropuncture study of renal sodium retention in nephrotic syndrome in rats: Evidence for increased resistance to tubular fluid flow. Kidney International 16: 561–571 (1979)PubMedGoogle Scholar
  76. Lancestremere, R.G.; Davidson, P.L.; Earley, L.E.; O’Brian, F.J. and Papper, S.: Renal failure in Laenec’s cirrhosis. II. Simultaneous determination of cardiac output and renal hemodynamics. Journal of Clinical Investigation 41: 1922–1927 (1962)PubMedGoogle Scholar
  77. Laragh, J.H.: Hormones and the pathogenesis of congestive heart failure. Vasopressin, aldosterone, and angiotensin. II. Further evidence for renal-adrenal interaction from studies in hypertension and in cirrhosis. Circulation 25: 1015–1023 (1962)PubMedGoogle Scholar
  78. Levin, M.L.: Hyponatremic syndromes. Medical Clinics of North America 62: 1257–1272 (1978)PubMedGoogle Scholar
  79. Levinsky, N.G. and Lalone, R.C.: Sodium excretion during acute saline loading in dogs with venacaval constriction. Journal of Clinical Investigation 44: 565–573 (1965)PubMedGoogle Scholar
  80. Levy, M.: Effects of acute volume expansion and altered hemodynamics on renal tubular function in chronic caval dogs. Journal of Clinical Investigation 51: 922–937 (1972)PubMedGoogle Scholar
  81. Lewy, J.E. and Windhager, E.E.: Peritubular control of proximal tubular fluid reabsorption in the rat kidney. American Journal of Physiology 214: 943–954 (1968)PubMedGoogle Scholar
  82. Mashford, M.L.; Mahon, W.A. and Chalmers, T.C.: Studies of the cardiovascular system in the hypotension of liver failure. New England Journal of Medicine 267: 1071–1074 (1962)PubMedGoogle Scholar
  83. Myers, B.D.; Deen, W.M. and Brenner, B.M.: Effects of norepinephrine and angiotensin II on the determinants of glomerular Ultrafiltration and proximal tubule fluid reabsorption in the rat. Circulation Research 37: 101–110 (1975)PubMedGoogle Scholar
  84. Neumann, K.H. and Rector, F.C.: Mechanism of NaCl and water reabsorption in the proximal convoluted tubule of rat kidney. Journal of Clinical Investigation 58: 1110–1118 (1976)PubMedGoogle Scholar
  85. Nicholls, M.G.; Espiner, E.A.; Donald, R.A. and Hughes, H.: Aldosterone and its regulation during diuresis in patients with gross congestive heart failure. Clinical Science and Molecular Medicine 47: 301–315 (1974)PubMedGoogle Scholar
  86. Ochs, H.R.; Greenblatt, D.J.; Bodem, G. and Smith, T.W.: Spironolactone. American Heart Journal 96: 389–400 (1978)PubMedGoogle Scholar
  87. Odlind, B.: Relation between renal tubular secretion and effects of five loop diuretics. Journal of Pharmacology and Experimental Therapeutics 211: 238–211 (1979)aPubMedGoogle Scholar
  88. Odlind, B.: Relationship between tubular secretion of furosemide and its saluretic effect. Journal of Pharmacology and Experimental Therapeutics 208: 515–521 (1979)bPubMedGoogle Scholar
  89. Oliw, E.; Kover, G.; Larsson, C. and Anggard, E.: Reduction by indomethacin of furosemide effects in the rabbit. European Journal of Pharmacology 38: 95–100 (1976)PubMedGoogle Scholar
  90. Olsen, U.B.: Indomethacin inhibition of bumetanide diuresis in dogs. Acta Pharmacologica et Toxicologica 37: 65–78 (1975)PubMedGoogle Scholar
  91. Onen, K.H.: Renal hemodynamics in hepatic cirrhosis. Lancet 1: 203–204 (1960)PubMedGoogle Scholar
  92. Papper, S. and Rosenbaum, J.D.: Abnormalities in the excretion of water and sodium in ‘compensated’ cirrhosis of the liver. Journal of Laboratory and Clinical Medicine 40: 523–530 (1952)PubMedGoogle Scholar
  93. Patak, R.V.; Fadem, S.Z.; Rosenblatt, S.G.; Lifschitz, M.D. and Stein, J.H.: Diuretic-induced changes in renal blood flow and prostaglandin E excretion in the dog. American Journal of Physiology 5: F495–F500 (1979)Google Scholar
  94. Patak, R.V.; Mookerjee, B.K.; Bentzel, C.J.; Hysert, P.E.; Babej, M. and Lee, J.B.: Antagonism of the effects of furosemide by indomethacin in normal and hypertensive man. Prostaglandins 10:649–659 (1975)PubMedGoogle Scholar
  95. Puschett, J.B. and Goldberg, M.: The acute effects of furosemide on acid and electrolyte excretion in man. Journal of Laboratory and Clinical Medicine 71: 666–677 (1968)PubMedGoogle Scholar
  96. Puschett, J.B. and Rastegar, A.: Comparative study of the effects of metolazone and other diuretics on potassium excretion. Clinical Pharmacology and Therapeutics 15: 397–405 (1974)Google Scholar
  97. Rector, F.C.; Carter, N.W. and Seldin, D.W.: The mechanism of bicarbonate reabsorption in the proximal and distal tubules of the kidney. Journal of Clinical Investigation 44: 278–290 (1965)PubMedGoogle Scholar
  98. Rector, F.C.; Sellman, J.C.; Martinez-Maldonado, M. and Seldin, D.W.: The mechanism of suppression of proximal tubular reabsorption by saline infusions. Journal of Clinical Investigation 46: 47–56 (1967)PubMedGoogle Scholar
  99. Rose, H.J.; O’Malley, K. and Pruitt, A.W.: Depression of renal clearance of furosemide in man by azotemia. Clinical Pharmacology and Therapeutics 21: 141–146 (1976)aGoogle Scholar
  100. Rose, H.J.; Pruitt, A.W. and McNay, J.L.: Effect of experimental azotemia on renal clearance of furosemide in the dog. Journal of Pharmacology and Experimental Therapeutics 196: 238–247 (1976)bPubMedGoogle Scholar
  101. Rose, H.J.; Pruitt, A.W.; Dayton, P.G. and McNay, J.L.: Relationship of urinary furosemide excretion rate to natriuretic effect in experimental azotemia. Journal of Pharmacology and Experimental Therapeutics 199: 490–497 (1976)cPubMedGoogle Scholar
  102. Rosin, J.M.; Katz, M.A.; Rector, F.C. and Seldin, D.W.: Acetazolamide in studying sodium reabsorption in diluting segment. Am. J. Physiol. 219: 1731–1738 (1970)PubMedGoogle Scholar
  103. Sanders, L.L. and Melby, J.C.: Aldosterone and the edema of congestive heart failure. Archives of Internal Medicine 113: 331–341 (1964)PubMedGoogle Scholar
  104. Scherer, B. and Weber, P.C.: Time-dependent changes in prostaglandin excretion in response to frusemide in man. Clinical Science 56: 77–81 (1979)PubMedGoogle Scholar
  105. Schroeder, E.T.; Eich, R.H.; Smulyan, H.; Gould, A.B. and Gabuzda, G.J.: Plasma renin level in hepatic cirrhosis. Relation to functional renal failure. American Journal of Medicine 49: 186–191 (1970)PubMedGoogle Scholar
  106. Seely, J.F. and Dirks, J.H.: Site of action of diuretic drugs. Kidney International 11: 1–8 (1977)PubMedGoogle Scholar
  107. Seldin, D.W. and Rector, F.C: Evaluation of clearance methods for localization of site of action of diuretics. Excerpta Medica 268: 97–111 (1972)Google Scholar
  108. Seldin, D.W.; Eknoyan, G., Suki, W.N. and Rector, F.C.: Localization of diuretic action from the pattern of water and electrolyte excretion. Annals of the New York Academy of Sciences 139: 328–343 (1966)PubMedGoogle Scholar
  109. Smith, D.E.; Brater, D.C.; Lin, E.T. and Benet, L.Z.: Attenuation of furosemide’s diuretic effect by indomethacin: Pharmacokinetic evaluation. Journal of Pharmacokinetic Biopharmacy 7: 265–274 (1979)Google Scholar
  110. Sparks, H.V.; Kopald, H.H.; Carriere, S.; Chimoskey, J.E.; Kinoshita, M. and Barger, A.C.: Intrarenal distribution of blood flow with chronic congestive heart failure. American Journal of Physiology 223: 840–846 (1972)PubMedGoogle Scholar
  111. Stason, W.B.; Cannon, P.J.; Heinemann, H.O. and Laragh, J.H.: Furosemide: A clinical evaluation of its diuretic action. Circulation 34: 910–920 (1966)PubMedGoogle Scholar
  112. Stein, J.H.; Boonjarern, S.; Wilson, C.B. and Ferris, T.F.: Alterations in intrarenal blood flow distribution. Methods of measurement and relationship to sodium balance. Circulation Research 32 (Suppl. I): 61–71 (1973)PubMedGoogle Scholar
  113. Steinmuller, S.R. and Puschett, J.B.: Effects of metolazone in man: Comparison with chlorothiazide. Kidney International 1: 169–181 (1972)PubMedGoogle Scholar
  114. Stumpe, K.O.; Solle, H.; Klein, H. and Kruck, F.: Mechanism of sodium and water retention in rats with experimental heart failure. Kidney International 4: 309–317 (1973)PubMedGoogle Scholar
  115. Tristani, F.E. and Cohn, J.N.: Systemic and renal hemodynamics in oliguric hepatic failure. Effect of volume expansion. Journal of Clinical Investigation 46: 1894–1906 (1967)PubMedGoogle Scholar
  116. Vander, A.; Malvin, R.; Wilde, W.S. and Sullivan, L.P.: Localization of the site of action of chlorothiazide by stop-flow analysis. Journal of Pharmacology and Experimental Therapeutics 125: 19–22 (1959)PubMedGoogle Scholar
  117. Vecsei, P.; Dusterdieck, G.; Jahnecke, J.; Lommer, D. and Wolff, H.P.: Secretion and turnover of aldosterone in various pathological states. Clinical Sciences 36: 241–256 (1969)Google Scholar
  118. Vidt, D.G.: Diuretics: Use and misuse. Postgraduate Medicine 59: 143–150 (1976)PubMedGoogle Scholar
  119. Vlahcevic, Z.R.; Adham, N.F.; Jick, H.; Moore, E.W. and Chalmers, T.C.: Renal effects of acute expansion of plasma volume in cirrhosis. New England Journal of Medicine 272: 387–391 (1965)PubMedGoogle Scholar
  120. Watkins, L.; Burton, J.A.; Haber, E.; Cant, J.R.; Smith, F.W. and Barger, A.C.: The renin-angiotensin-aldosterone system in congestive failure in conscious dogs. Journal of Clinical Investigation 57: 1606–1617 (1976)PubMedGoogle Scholar
  121. Weber, P.C.; Scherer, B. and Larsson, C.: Increase of free arachidonic acid by furosemide in man as the cause of prostaglandin and renin release. European Journal of Pharmacology 41: 329–332 (1977)PubMedGoogle Scholar
  122. Weiner, M.W.; Weinman, E.J.; Kasgarian, M. and Hayslett, J.P.: Accelerated reabsorption in the proximal tubule produced by volume depletion. Journal of Clinical Investigation 50: 1379–1385 (1971)PubMedGoogle Scholar
  123. Wilkinson, S.P.; Arroyo, V.; Moodie, H.E.; Blendis, L.M. and Williams, R.: Renal failure and site of abnormal renal retention of sodium in fulminant hepatic failure. Gut 15: 343 (1974)PubMedGoogle Scholar
  124. Wilkinson, S.P.; Jowett, T.P.; Slater, J.D.H.; Arroyo, V.; Moodie, H. and Williams, R.: Renal sodium retention in cirrhosis: Relation to aldosterone and nephron site. Clinical Sciences and Molecular Medicine 56: 169–177 (1979)aGoogle Scholar
  125. Wilkinson, S.P.; Smith, I.K. and Williams, R.: Changes in plasma renin activity in cirrhosis: A reappraisal based on studies in 67 patients and ‘low-renin’ cirrhosis. Hypertension 1: 125–129 (1979)bPubMedGoogle Scholar
  126. Williamson, H.E.; Bourland, W.A. and Marchand, G.R.: Inhibition of ethacrynic acid induced increase in renal blood flow by indomethacin. Prostaglandins 25: 297–301 (1974)Google Scholar
  127. Williamson, H.E.; Bourland, W.A. and Marchand, G.R.: Inhibition of furosemide induced increase in renal blood flow by indomethacin. Proceedings of the Society for Experimental Biology and Medicine 148: 164–167 (1975)aGoogle Scholar
  128. Williamson, H.E.; Bourland, W.A.; Marchand, G.R.; Farley, D.B. and Van Orden, D.E.: Furosemide induced release of prostaglandin E to increase renal blood flow. Proceedings for the Society of Experimental Biology and Medicine 150: 104–106 (1975)bGoogle Scholar
  129. Williamson, H.E.; Gaffney, G.R.; Bourland, W.A.; Farley, D.B. and Van Orden, D.E.: Phenylbutazone-induced decrease in renal blood flow. Journal of Pharmacology and Experimental Therapeutics 204: 130–134 (1978)PubMedGoogle Scholar
  130. Windhager, E.E.: Some aspects of proximal tubular salt reabsorption. Federation Proceedings 33: 21–24 (1974)PubMedGoogle Scholar
  131. Windhager, E.E. and Giebisch, G.: Proximal sodium and fluid transport. Kidney International 9: 121–133 (1976)PubMedGoogle Scholar
  132. Yarger, W.E.: Intrarenal mechanisms of salt retention after bile duct ligation in rats. Journal of Clinical Investigation 57: 408–418 (1976)PubMedGoogle Scholar

Copyright information

© ADIS Press Australasia Pty Ltd 1981

Authors and Affiliations

  • D. Craig Brater
    • 1
  1. 1.Department of PharmacologyThe University of Texas Health Science Center at DallasDallasUSA

Personalised recommendations