The Influence of Diuretics on the Fractional Fluid and Electrolyte-Excretion in Renal Insufficiency

  • A. Heidland
  • K. Klütsch
  • H. Hennemann
  • U. Löwenstein
  • H. J. Kuschke


In patients with renal insufficiency, ethacrynie acid and furosemide effect a more potent filtrate-dependent diuresis than in healthy renal subjects. This effect is demonstrable up to a reduction of filtrate to 10 ml/min. Under azetolamide, only in cases of moderate limitation of renal function (GFR 80–40 ml/min), a relative increase of effect could be shown.

Hydrochlorothiazide does not cause a definite change of effect in the individual filtrate-sectors.

Humoral factors, among others, might be discussed as the origin of the varying filtrate-dependent excretion. To explicate the foregoing : Increases by the 1.3 to 10.0 fold of the control value were seen in determinations of the pyrocatechin amines in the urine after application of 20 mg furosemide, whereby the rise was registered as directly proportional to the glomeru-lum filtration and to the absolute fluid excretion.

In addition, furosemide and ethacrynie acid caused direct activation of the renin/angiotensin-system which is at its maximum at the peak of diuresis.

It is assumed that the antidiuretic and sodium-retaining properties of pyrocatechin amines and angiotensin diminish the effect of the diuretic on the nephron. This effect ought to present itself more extensively in healthy renal subjects due to a higher total fluid excretion and stronger activation of humoral factors than in patients with renal insufficiency, who, in addition are “protected” by an osmotic diuresis.


Ethacrynic Acid Fractional Fluid Osmotic Diuresis Fluid Excretion Acute Renal Damage 
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Der Einfluß von Diuretica auf die fraktionelle Flüssigkeits- und Elektrolytexcretion bei eingeschränkter Nierenfunktion


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Literatur / References

  1. Biber, Th., M. Mylle, A. P. Baines, C.W. Gottschalk, J. Oliver and McDowell: Study by mieropuncture and microdissection of acute renal damage in rats. Am. J. Med. 44, 664 (1968).PubMedCrossRefGoogle Scholar
  2. Book, K. D., H. Dengler, H. J. Krecke und G. Reichel: Untersuchungen über die Wirkung von synthetischem Hypertensin II auf Elektrolythaushalt, Nierenfunktion und Kreislauf beim Menschen. Klin.Wschr. 36, 808 (1958).CrossRefGoogle Scholar
  3. Bricker, N. S., S. Klahb and R. E. Rieselbach: The functional adaptation of the diseased kidney. J. Clin. Invest. 43, 1915 (1964).PubMedCrossRefGoogle Scholar
  4. Brown, J. J. and W. S. Peart: The effect of angiotensin on urine flow and electrolyte excretion in hypertensive patients. Clin. Sci. 22, 1 (1962).PubMedGoogle Scholar
  5. Brünnee, F. P., F. C. Rector and D.W. Seldin: Mechanism of glomerular-tubular balance. J. Clin. Invest. 45, 590 (1966).CrossRefGoogle Scholar
  6. Btjchborn, E. und S. Anastasakis: Angriffspunkt und Wirkungsmechanismus von Furosemid am distalen Nephron des Menschen. Klin.Wschr. 42, 22, 1127 (1964).CrossRefGoogle Scholar
  7. Deetjen, P.: Mikropunktionsuntersuchungen zur Wirkung von Furosemid. Pflügers Arch. ges. Physiologie 284, 184 (1965).Google Scholar
  8. Deetjen, P.: Mieropuncture studies on site and mode of diuretic action of furosemide. Ann. New York Acad. Sci. 139, 408 (1966).CrossRefGoogle Scholar
  9. Deetjen, P., W. E. Bítntig, K. Hardt and R. Rhode: Diuretic effect of ethacrynic acid in the rat: A mieropuncture study of the relationship of site and mode of action. ö.Symp. f. Nephrologie, Lausanne 1967.Google Scholar
  10. Dirks, J. H., W. J. Cirksena and R. W. Berliner: The effect of saline infusion on sodium reabsorption by the proximal tubule of the dog. J. Clin. Invest. 44, 1160 (1965).PubMedCrossRefGoogle Scholar
  11. Edel, H.H., J. Eigler und E. Renner: Zum Wirkungsmechanismus der Etacrynsäure. Klin. Wschr. 44, 8, 421 (1966).PubMedCrossRefGoogle Scholar
  12. Fraser, R., V. H. T. James, J. J. Brown, P. Isaac and A. F. Lever: Effect of angiotensin and of frusemide on plasma aldosterone, corticosterone, Cortisol, and renin in man. Lancet 11, 989 (1965).CrossRefGoogle Scholar
  13. Gobdon, R. D., O. Küchel, G. W. Liddhe and P. Is:lant>: Role of the sympathetic nervous system in regulating renin and aldosterone production in man. J. Clin. Invest. 46 4 (1967).Google Scholar
  14. Heidland, A., K. Klütsch, T. Takttma und E. Scheitza: Funktionelle Aspekte der chronischen Niereninsuffîzienz mit Urämie. 5.Symp. Ges. f. Nephrologie, Lausanne 1967.Google Scholar
  15. Johnston, C. L. and J. O. Davis: Evidence from cross circulation studies for a humoral mechanism in the natriuresis of saline loading. Proc. Soc. exp. Biol. (N. Y.) 121, 1058 (1966).Google Scholar
  16. Kjlaus, D. und D. Bocskob: Zur Regulation der Reninsekretion beim Menschen. Verhandl. dtsch. Ges. inn. Med. 1968 im Druck.Google Scholar
  17. Kuschke, H. J. und R. Hebzeb: Die Brenzkatechinaminausscheidung bei essentieller Hypertonie unter orthostatischer Belastung. Verh. Dtsch. Ges. Kreislauff. 28, 232 (1963).Google Scholar
  18. Labagh, J. H.: Interrelationship between angiotensin, norepinephrine, epinephrine, aldosterone secretion and electrolyte metabolism in man. Circulation 25, 203 (1962).Google Scholar
  19. Meyer, Ph., J. Menabd, J. M. Alexandbe and P. Mtlliez: Variations de l’activité reniñe plasmatique après injection d’acide éthacrynique. J. Urol. Néphrol. 72, 619 (1966).Google Scholar
  20. Nicolosi, G. and R. Santobo: La eliminazione urinaria de catecholamine réel corso di deplezione idrosalina. Prog. med. (Napoli) 20, 289 (1964).Google Scholar
  21. Nickel, J. F., P. B. Lowbance, E. Leifeb and S. E. Bbadley: Renal function, electrolyte excretion and body fluids in patients with chronic renal insufficiency before and after sodium deprivation. J. Clin. Invest. 32, 68 (1953).PubMedCrossRefGoogle Scholar
  22. Pobtjsh, J. G. and R. G. Abbamson: The effects of hypertonic mannitol on renal sodium excretion in hydropenic man. Clin. Sci. 29, 475 (1965).Google Scholar
  23. Rectob, C. F., J. C. Sellman, M. Mabtinez-Maldonado and D. W. Seldin: The mechanism of suppression of proximal tubular reabsorption by saline infusions. J. Clin. Invest. 46, 1 (1967).CrossRefGoogle Scholar
  24. Reubi, F. C.: Clinical use of furosemide. Ann. New York Acad. Sci. 139, 433 (1966).CrossRefGoogle Scholar
  25. Reubi, F. und C. Vobbtjbgeb: Wirkung der Diurética bei eingeschränkter Nierenfunktion. In: Diureseforschung IV. Symp. Freiburg 1966, Georg Thieme Verlag Stuttgart.Google Scholar
  26. Rosenthal, J., R. Bottcheb, W. Nowacynski and J. Genest: Acute changes in plasma volume, renin activity and free aldosterone levels in healthy subjects following furosemide administration. Can. J. Physiol. Pharmacol. 46, 85 (1966).CrossRefGoogle Scholar
  27. Thubatj, K.: Intrarenale Wirkung des Angiotensins. In : Renaler Transport und Diurética. Springer, Berlin, Heidelberg, New York 1969.Google Scholar
  28. Vandeb, A. J.: Effect of catecholamines and the renal nerves on renin secretion in unanesthe-tized dogs. Am. J. Physiol. 209, 659 (1965).Google Scholar
  29. Wathem, R. L., W. S. Kingsbtjby, D. A. Stoudeb, E. G. Schneideb and H. H. Rostobfeb: Effects of infusion of catecholamines and angiotensin II on renin release in unanesthetized dogs. Amer. J. Physiol. 209, 1012 (1965).Google Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1969

Authors and Affiliations

  • A. Heidland
  • K. Klütsch
  • H. Hennemann
  • U. Löwenstein
  • H. J. Kuschke

There are no affiliations available

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