The Use of Diuretics



It has been established that pretreatment of the subject with vigorous hy­dration, osmotic diuretics, or loop diuretics pro­tects the kidney from some forms of renal injury.

Accordingly, patients who will be exposed to po­tentially injurious stimuli such as radiocontrast dyes, vascular surgery, or nephrotoxic drugs should be maintained with high rates of urine flow and replete extracellular fluid volumes. The value of diuretics when administered after the in­jurious insult is controversial. Most studies in­dicate that diuretics do not alter the severity or the duration of ATN. Loop-acting diuretics, how­ever, may convert oliguric ATN into a polyuric form. Some clinicians therefore advocate admin­istration of a bolus dose of a loop-acting diuretic once the diagnosis is established. If the diuretic fails to induce a diuretic response, it is discon­tinued. Although the diuretics do not alter the course of ATN, it is generally easier to manage the polyuric as compared to the oliguric form of ATN.