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Li S, He X, Ruan L, Ye T, Wen Y, Song Z, Hu S, Chen Y, Peng B, Li S. Protective Effect of Mannitol on Cisplatin-Induced Nephrotoxicity: A Systematic Review and Meta-Analysis. Front Oncol 2022; 11:804685. [PMID: 34976843 PMCID: PMC8716592 DOI: 10.3389/fonc.2021.804685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Cisplatin, a chemotherapeutic drug, is widely used for the treatment of various malignant tumors with good effects. However, cisplatin-induced nephrotoxicity is a major dose-limiting factor and a significant adverse event. Mannitol is used to reduce cisplatin-induced nephrotoxicity, which is controversial. This study aimed to evaluate the efficacy and safety of a hydration regimen containing mannitol against cisplatin-induced nephrotoxicity through a meta-analysis. METHODS Potential records from PubMed, EMBASE, Cochrane Library, and ClinicalTrials that met the inclusion criteria were included from inception to May 2021. Cochrane Collaboration tools were used to assess the risk of bias in the included studies. Jadad's and NOS scores were applied to assess the quality of randomized controlled trials (RCTs) and case-control studies. A random-effects model or fixed-effects model was used depending on the heterogeneity. Subgroup analyses were performed to evaluate the potential study characteristics. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were evaluated. RESULTS Four RCTs and seven case-control studies involving 4168 patients were included. Pooled results showed that mannitol use could reduce the incidence of cisplatin-induced nephrotoxicity (OR = 0.66, 95% CI [0.45-0.97], p = 0.03), especially reducing grade 3 nephrotoxicity events according to CTCAE 4.0 (OR = 0.37,95% CI [0.16-0.84]). Moreover, mannitol use was not significantly associated with creatinine clearance, serum creatine, and electrolyte disturbance (p > 0.05). Gastrointestinal cancer (OR = 0.36, 95% CI [0.15-0.83], p = 0.02) and urinary tract cancer (OR = 0.32,95% CI [0.14-0.73], p = 0.007) may be more sensitive to mannitol, although the test for overall effect was significantly different (OR = 0.66, 95% CI [0.49-0.89], p = 0.007). For patients with diabetes and hypertension, mannitol may worsen renal function (OR = 1.80, 95% CI [1.18-2.72], p = 0.006; OR = 2.19, 95% CI [1.50, 3.19], p < 0.0001, respectively). Mannitol may have a better protective effect when doses of mannitol were ≥ 25 g (OR = 0.58, 95% CI [0.39-0.88], p = 0.01) and doses of cisplatin < 75 mg/m2 (OR = 0.59, 95% CI [0.36-0.94], p = 0.03). It revealed that mannitol use was likely to cause nausea or vomiting (OR = 1.86, 95% CI [1.20-2.89], p = 0.006). CONCLUSION Current evidence revealed that mannitol was an effective and safe drug to reduce cisplatin-induced nephrotoxicity events, especially Grade 3 events. However, it may cause more nausea/vomiting events and deteriorate renal function in patients with diabetes or hypertension. We also found that mannitol had the best effect when mannitol was ≥ 25 g in total or cisplatin was < 75 mg/m2. Meanwhile, mannitol may have a better effect on gastrointestinal and urinary tract cancers. SYSTEMATIC REVIEW REGISTRATION crd. york. ac. uk/PROSPERO, CRD 42021253990.
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Affiliation(s)
- Songtao Li
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Clinical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiuyun He
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linjie Ruan
- Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Ting Ye
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yulong Wen
- Clinical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhihua Song
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Siying Hu
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Chen
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bo Peng
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shijie Li
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Yang D, Guo H, Guo D, Wang Z, Guo S, Liu J, Wang M, Xu Y, Zhang P, Wang G, Zhang J, Ning X, Li X, Wang J. Association between kidney function and hearing impairment among middle-aged and elderly individuals: a cross-sectional population-based study. Postgrad Med 2021; 133:701-706. [PMID: 34030596 DOI: 10.1080/00325481.2021.1933554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE As age-related diseases, chronic kidney disease and hearing impairment (HI) cause a serious socioeconomic burden. Due to structural similarities, there is a certain connection between kidney function and hearing, but there has been no large-scale epidemiological study in China that further explored this connection. Thus, this study aimed to explore the association between indicator levels of kidney function and hearing impairment among middle-aged and elderly individuals in Tianjin, China. METHOD In 2020, 1539 participants aged 45 years or older from Tianjin, China, were recruited into this study. All participants completed questionnaire surveys and underwent physical examinations, laboratory examinations, and hearing tests. The estimated glomerular filtration rate (eGFR) was calculated from serum creatinine (Cre) levels. HI was measured using pure-tone audiometry, and audiologists determined the final diagnoses. RESULT The prevalence of HI was 49.97%. With each 1-mL/min/1.73 m2 increase in eGFR, the overall odds of HI increased by 1.3%; the risk increased by 2.4% and 1.6% for men and people aged 45-65 years, respectively. In contrast, in women, the odds of HI increased as Cre levels increased. Moreover, with each 1-mL/min/1.73 m2 increase in eGFR, the overall odds of a one-degree increase in hearing loss increased by 1.7%; the odds increased by 2.3% and 1.5% for men and people aged 45-65 years, respectively. However, in women and people aged ≥65 years, the odds of a one-grade increase in hearing loss increased by 2.1% and 1.5%, respectively, with each 1-µmol/L increase in Cre. In addition, there were no significant relationships between blood urea nitrogen and hearing loss in multivariate analysis (all P > 0.05). CONCLUSIONS These findings suggest that eGFR and serum Cre are effective predictors of hearing loss. Thus, to decrease the burden of HI, hearing should be carefully monitored for people aged ≥45 years with elevated serum Cre and eGFR.
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Affiliation(s)
- Dong Yang
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huiying Guo
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Dandan Guo
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhenyu Wang
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Sitong Guo
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute., Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China
| | - Mingxin Wang
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yi Xu
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Peng Zhang
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Gaoyu Wang
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jing Zhang
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute., Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China
| | - Xin Li
- Department of Otorhinolaryngology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute., Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China
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Gauvin DV, Zimmermann ZJ, Yoder J, Tapp R, Baird TJ. Predicting the Need for a Tier II Ototoxicity Study From Early Renal Function Data. Int J Toxicol 2019; 38:265-278. [PMID: 31220989 DOI: 10.1177/1091581819851232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
History has established that many drugs, such as the antibiotics, chemotherapies, and loop diuretics, are capable of inducing both nephrotoxicity and ototoxicity. The exact mechanisms by which cellular damage occurs remain to be fully elucidated. Monitoring the indices of renal function conducted in the Food and Drug Administration's prescribed set of early investigational new drug (IND)-enabling studies may be the first signs of ototoxicity properties of the new drug candidate. In developing improved and efficacious new molecular entities, it is critically necessary to understand the cellular and molecular mechanisms underlying the potential ototoxic effects as early in the drug development program as possible. Elucidation of these mechanisms will facilitate the development of safe and effective clinical approaches for the prevention and amelioration of drug-induced ototoxicity prior to the first dose in man. Biomarkers for nephrotoxicity in early tier I or tier II nonclinical IND-enabling studies should raise an inquiry as to the need to conduct a full auditory function assay early in the game to clear the pipeline with a safer candidate that has a higher probability of continued therapeutic compliance once approved for distribution.
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Affiliation(s)
- David V Gauvin
- 1 Neurobehavioral Sciences Department, Charles River Laboratories, Inc, Mattawan, MI, USA
| | - Zachary J Zimmermann
- 1 Neurobehavioral Sciences Department, Charles River Laboratories, Inc, Mattawan, MI, USA
| | - Joshua Yoder
- 1 Neurobehavioral Sciences Department, Charles River Laboratories, Inc, Mattawan, MI, USA
| | - Rachel Tapp
- 1 Neurobehavioral Sciences Department, Charles River Laboratories, Inc, Mattawan, MI, USA
| | - Theodore J Baird
- 2 Safety Assessment, Charles River Laboratories, Inc, Mattawan, MI, USA
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Pacifici GM. Clinical pharmacology of furosemide in neonates: a review. Pharmaceuticals (Basel) 2013; 6:1094-129. [PMID: 24276421 PMCID: PMC3818833 DOI: 10.3390/ph6091094] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 08/28/2013] [Accepted: 08/30/2013] [Indexed: 11/16/2022] Open
Abstract
Furosemide is the diuretic most used in newborn infants. It blocks the Na+-K+-2Cl− symporter in the thick ascending limb of the loop of Henle increasing urinary excretion of Na+ and Cl−. This article aimed to review the published data on the clinical pharmacology of furosemide in neonates to provide a critical, comprehensive, authoritative and, updated survey on the metabolism, pharmacokinetics, pharmacodynamics and side-effects of furosemide in neonates. The bibliographic search was performed using PubMed and EMBASE databases as search engines; January 2013 was the cutoff point. Furosemide half-life (t1/2) is 6 to 20-fold longer, clearance (Cl) is 1.2 to 14-fold smaller and volume of distribution (Vd) is 1.3 to 6-fold larger than the adult values. t1/2 shortens and Cl increases as the neonatal maturation proceeds. Continuous intravenous infusion of furosemide yields more controlled diuresis than the intermittent intravenous infusion. Furosemide may be administered by inhalation to infants with chronic lung disease to improve pulmonary mechanics. Furosemide stimulates prostaglandin E2 synthesis, a potent dilator of the patent ductus arteriosus, and the administration of furosemide to any preterm infants should be carefully weighed against the risk of precipitation of a symptomatic patent ductus arteriosus. Infants with low birthweight treated with chronic furosemide are at risk for the development of intra-renal calcifications.
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Affiliation(s)
- Gian Maria Pacifici
- Section of Pharmacology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56100, Italy.
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Baldwin KA, Budzinski CE, Shapiro CJ. Acute Sensorineural Hearing Loss: Furosemide Ototoxicity Revisited. Hosp Pharm 2008. [DOI: 10.1310/hpj4312-982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lang F, Vallon V, Knipper M, Wangemann P. Functional significance of channels and transporters expressed in the inner ear and kidney. Am J Physiol Cell Physiol 2007; 293:C1187-208. [PMID: 17670895 DOI: 10.1152/ajpcell.00024.2007] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A number of ion channels and transporters are expressed in both the inner ear and kidney. In the inner ear, K+cycling and endolymphatic K+, Na+, Ca2+, and pH homeostasis are critical for normal organ function. Ion channels and transporters involved in K+cycling include K+channels, Na+-2Cl−-K+cotransporter, Na+/K+-ATPase, Cl−channels, connexins, and K+/Cl−cotransporters. Furthermore, endolymphatic Na+and Ca2+homeostasis depends on Ca2+-ATPase, Ca2+channels, Na+channels, and a purinergic receptor channel. Endolymphatic pH homeostasis involves H+-ATPase and Cl−/HCO3−exchangers including pendrin. Defective connexins (GJB2 and GJB6), pendrin (SLC26A4), K+channels (KCNJ10, KCNQ1, KCNE1, and KCNMA1), Na+-2Cl−-K+cotransporter (SLC12A2), K+/Cl−cotransporters (KCC3 and KCC4), Cl−channels (BSND and CLCNKA + CLCNKB), and H+-ATPase (ATP6V1B1 and ATPV0A4) cause hearing loss. All these channels and transporters are also expressed in the kidney and support renal tubular transport or signaling. The hearing loss may thus be paralleled by various renal phenotypes including a subtle decrease of proximal Na+-coupled transport (KCNE1/KCNQ1), impaired K+secretion (KCNMA1), limited HCO3−elimination (SLC26A4), NaCl wasting (BSND and CLCNKB), renal tubular acidosis (ATP6V1B1, ATPV0A4, and KCC4), or impaired urinary concentration (CLCNKA). Thus, defects of channels and transporters expressed in the kidney and inner ear result in simultaneous dysfunctions of these seemingly unrelated organs.
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Affiliation(s)
- Florian Lang
- Department of Physiology, Eberhard-Karls-University of Tübingen, Gmelinstrasse 5, Tübingen, Germany.
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Rybak LP, Whitworth C, Scott V. Comparative acute ototoxicity of loop diuretic compounds. Eur Arch Otorhinolaryngol 1991; 248:353-7. [PMID: 1930985 DOI: 10.1007/bf00169028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A microelectrode was used to measure endocochlear potentials (EP) in adult chinchillas and to study the effects of a series of loop diuretics. EP was measured before, during and for several hours after the intravenous injection of the following loop diuretics: furosemide, piretanide, bumetanide, ethacrynic acid, indacrinone stereoisomers and ozolinone. The first four loop diuretics caused a substantial dose-related reduction of EP. The (-) isomer of indacrinone was found to cause a dose-related reduction of EP to a moderate degree. The (+) isomer of indacrinone and ozolinone caused very little change of EP, even in very high doses. Findings are consistent with data on the mechanism of action of these agents in the kidney.
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Affiliation(s)
- L P Rybak
- Department of Surgery, Southern Illinois University School of Medicine, Springfield 62794-9230
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Syka J. Experimental Models of Sensorineural Hearing Loss — Effects of Noise and Ototoxic Drugs on Hearing. PROGRESS IN SENSORY PHYSIOLOGY 9 1989. [DOI: 10.1007/978-3-642-74058-9_3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Furosemide is an ototoxic diuretic. Furosemide injection is followed by a rapid, but reversible decrease of the endocochlear potential and eighth nerve action potential with a more gradual decrease of the endolymph potassium concentration. In contrast to the reversible effects of furosemide alone on the cochlea, the combination of kanamycin with furosemide resulted in irreversible changes in cochlear function which were associated with elevated levels of kanamycin in the blood and perilymph of the experimental animals. There was a striking similarity between the blood level measured by high pressure liquid chromatography at the time of recovery of auditory function in experimental animals and the ototoxic blood levels proposed by others in clinical literature. These findings help to provide a pharmacologic basis for the clinical observation of furosemide-induced hearing loss.
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Abstract
Chinchillas were anesthetized with ketamine (40 mg/kg i.m.) and endocochlear potential (EP) and potassium concentration in endolymph (Ke+) were determined in control animals and in animals injected with various doses of furosemide (25, 50 or 100 mg/kg i.v.) by means of microelectrodes inserted into scala media. Control EP and Ke+ in the chinchilla were 81.3 +/- 3.8 mV and 158.5 +/- 3.2 mequiv./l, respectively. Following injection of furosemide, a dose-related fall in EP and Ke+ was observed. However, the EP declined much more rapidly than the Ke+, and recovered more quickly than the latter. The recovery of Ke+ tended to lag behind the EP recovery. The debate over whether potassium transport into endolymph and endocochlear potential generation are related or independent events is discussed in the light of recent literature and the present study.
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Bumm P, Berg M, Tiedtke M. [Chemical examination of submandibular saliva in facial paralysis (author's transl)]. ARCHIVES OF OTO-RHINO-LARYNGOLOGY 1980; 226:269-78. [PMID: 6161599 DOI: 10.1007/bf00455588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
Aminoglycoside antibiotics are frequently employed in the treatment of serious infections caused by aerobic gram negative bacilli. The use of these potent antibacterial agents is limited by the risks of ototoxicity and nephrotoxicity. Aminoglycosides are excreted by glomerular filtration at a rate proportional to the serum concentration. Impaired renal excretion reduces the rate of clearance from the serum. Utilizing information about aminoglycoside pharmacokinetics, the susceptibility of infecting pathogens to aminoglycosides, and risk factors for ototoxicity, physicians can attempt to optimize the administratioin of an aminoglycoside to maximize the therapeutic efficacy and to minimize the risk of ototoxicity. Periodic assessments of renal function and of aminoglycoside levels in the serum are essential to guide therapy. The otolaryngologist and audiologist must be able to provide information about ototoxicity to medical colleagues using these drugs. They should also be prepared to evaluate and follow patients who develop sensorineural inner ear dysfunction during or after a course of therapy with an aminoglycoside antibiotic.
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Rybak LP, Green TP, Juhn SK, Morizono T, Mirkin BL. Elimination kinetics of furosemide in perilymph and serum of the chinchilla. Neuropharmacologic correlates. Acta Otolaryngol 1979; 88:382-7. [PMID: 532613 DOI: 10.3109/00016487909137182] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study was done to determine the comparative elimination kinetics of furosemide from chinchilla perilymph and serum, and to correlate perilymph concentration with changes in endocochlear potential. The elimination kinetics of furosemide (FU) were determined in sera and perilymph obtained from chinchillas injected with 100 mg/kg i.v. of FU. Concentrations of FU exhibited a linear decay pattern in serum and perilymph over the initial 60 minutes. The rate of decline of furosemide levels in perilymph was about four times slower than the rate of fall in serum. Chronic treatment (25 mg/kg i.p. every 12 hours) did not appear to influence the level of drug at 60 minutes after a dose of FU (100 mg/kg IV). Chinchillas were also studied following doses of FU ranging from 25--200 mg/kg i.v. to see the effect on endocochlear potential (EP). A positive correlation was found between FU dosage, the maximum millivolt reduction of EP and the time to initiation of recovery of EP. The perilymph concentration of furosemide when the EP began to recover was 5 microgram/ml (1.5 x 10(-5) M). Knowledge of furosemide kinetics may ultimately be applied to prevent ototoxicity in patients.
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Abstract
Despite the bewildering number of diuretics available to the physician, these drugs can be divided into 4 main groups, characterised by their site of action on sodium reabsorption in the kidney. Drugs acting on the ascending limb of the loop of Henle have a powerful but short acting diuretic effect; they include frusemide, ethacrynic acid and bumetanide. The benzothiadiazines and related compounds have a moderate diuretic action spread over a longer period, whilst the potassium-sparing diuretics, triamterene, amiloride and spironolactone, have only a weak diuretic effect but a marked ability to diminish urinary potassium excretion. The fourth group is made up of miscellaneous substances which function as vasodilator or osmotic agents. The pathogenesis of oedema formation in heart failure is outlined and a logical approach to treatment suggested. Duiretics are being increasingly used in the treatment of non-oedematous states, in particular hypertension, diabetes insipidus and hypercalciuria; their exact role in pregnancy and acute renal failure remains controversial. Side-effects can be related to their effect on electrolyte excretion and include hypokalaemia, hyponatraemia, hyperkalaemia and hyperuricaemia. The incidence of disturbed carbohydrate tolerance in previously normal individuals is low. Other less common side-effects are also discussed.
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