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Table 22-1

Diuretics and Their Sites of Action

ReceptorsMain Site of ActionClinical UsesNotable Side Effects
Carbonic anhydraseCarbonic anhydraseProximal convoluted tubule

  • Altitude sickness

  • Glaucoma

Metabolic acidosis
Loop diureticsNa-K-2Cl cotransportMedullary thick ascending loop of HenleFirst-line diuretics in renal impairment

  • Ototoxicity

  • Alkalosis

  • Hypokalemia

ThiazidesNa-Cl cotransportCortical ascending loop of HenleFirst line therapy of hypertension

  • Alkalosis

  • Hypokalemia

  • Diabetes and dyslipidemia

  • Hyperuricemia

Osmotic diureticsProximal convoluted tubule and loop of Henle

  • Increased intracranial pressure

  • Oxygen free radical scavenging

  • Volume overload in CHF patients

  • Hypokalemia, hyponatremia, hypomagnesemia

Potassium-sparing diureticsEpithelial Na channelCollecting ductAdjuncts to loop diuretics or thiazidesHyperkalemia
Aldosterone blockersNa-K-ATPaseCollecting ductHeart failure with low ejection fractionHyperkalemia
Dopamine and fenoldopamD1Proximal tubule and loop of HenleRenal protection and hypertension treatment in critically ill patientsEffectiveness not substantiated
Brain natriuretic peptideNa-K-ATPaseCollecting ductManagement of decompensated heart failure
VasopressinV2Collecting ductSIADH, CHF, cirrhosis
AquaporinsAQPCollecting duct