Diuretic Resistance.
Diuretic Resistance.
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DOI：
10.1053/j.ajkd.2016.08.027
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发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Ellison DH
中科院分区：
文献类型：
--
作者：
Hoorn EJ;Ellison DH
利尿剂抵抗被定义为尽管使用了全剂量利尿剂但仍未能达到治疗所需的水肿减轻。利尿剂抵抗的原因包括对药物治疗或饮食钠限制的依从性差、药代动力学问题以及未被利尿剂阻断的肾单位部位钠重吸收的代偿性增加。为了说明利尿剂抵抗的病理生理学和治疗，我们描述了一个肾病综合征患者。尽管使用口服袢利尿剂，该患者仍出现全身凹陷性水肿和体重增加。肾病综合征可引起肠粘膜水肿，限制利尿剂的吸收。此外，患者的肾功能恶化，损害了利尿剂的肾小管分泌。他入院接受静脉袢利尿剂治疗。然而，这是无效的，可能是由于其他肾小管节段的代偿性钠重吸收。袢利尿剂与氨苯蝶啶（一种上皮钠通道阻滞剂）联合使用，有效减轻了体重和水肿。最近的数据表明，纤维蛋白溶酶在肾病尿可以激活上皮钠通道，可能有助于利尿剂的阻力，在这个病人。这个案例是用来说明和审查的机制，并可能的干预措施，在利尿剂抵抗。
Diuretic resistance is defined as a failure to achieve the therapeutically desired reduction in edema despite a full dose of diuretic. The causes of diuretic resistance include poor adherence to drug therapy or dietary sodium restriction, pharmacokinetic issues, and compensatory increases in sodium reabsorption in nephron sites that are not blocked by the diuretic. To illustrate the pathophysiology and management of diuretic resistance, we describe a patient with nephrotic syndrome. This patient presented with generalized pitting edema and weight gain despite the use of oral loop diuretics. Nephrotic syndrome may cause mucosal edema of the intestine, limiting the absorption of diuretics. In addition, the patient’s kidney function had deteriorated, impairing the tubular secretion of diuretics. He was admitted for intravenous loop diuretic treatment. However, this was ineffective, likely due to compensatory sodium reabsorption by other tubular segments. The combination of loop diuretics with triamterene, a blocker of the epithelial sodium channel, effectively reduced body weight and edema. Recent data suggest that plasmin in nephrotic urine can activate the epithelial sodium channel, potentially contributing to the diuretic resistance in this patient. This case is used to illustrate and review the mechanisms of, and possible interventions for, in diuretic resistance.
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影响因子：
2.5
作者：
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通讯作者：
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影响因子：
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