Drugs Affecting Renal Excretory Function

Abstract

Various classes of drugs that impact the renal function are used to cause diuresis or/and natriuresis to help in various clinicopathological states. They include carbonic anhydrase inhibitors, osmotic diuretics, loop diuretics, thiazide diuretics, ENaC channel inhibitors, aldosterone antagonists, and natriuretic peptides. Most of these drugs are used for their natriuretic potential in edema. There is a linear relationship between the extracellular volume and the urinary excretion of sodium. Diuretics alter this in such a way that similar rates of Na⁺ excretion happen at lower ECF. Reduction in the circulatory volume can be lifesaving in various conditions affecting the cardiovascular system and the renal system. Careful understanding of their mechanism of action is essential to understand the mechanisms of diuretic resistance which will eventually require consideration in a patient who is on long term diuretic therapy. Further, since the renal autoregulation plays an important role in maintaining the GFR, it is important to consider how various classes of drugs affect the renal autoregulatory mechanism. Drugs which act on the vasopressin system also alter the renal water handling and are useful in conditions where the ADH secretion is dysfunctional.