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Diuretics in pediatrics

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Abstract

Diuretics are frequently prescribed drugs and help managing several pathological conditions, including acute and chronic kidney disease, nephrotic syndrome, congestive heart failure, ascites, systemic and pulmonary hypertension. Diuretic classes include among others osmotic diuretics and carboanhydrase inhibitors, loop diuretics, thiazides, and potassium-sparing diuretics. In this educational article, we aim at reviewing indications, mechanisms of action, and side effects, as well as basic pharmacokinetics considerations and data on diuretics in children, supporting practicing clinicians in choosing (and understanding the background of) the best-suited diuretic regimen for the individual patient. Newer diuretic classes like vaptans and sodium glucose type 2 cotransporter inhibitors, the recent controversies on hydrochlorothiazide, and the issue of diuretic resistance, will also be briefly addressed.

Conclusion: This educational review offers a didactical overview of diuretics in Pediatrics.

What is Known:

• Diuretics are frequently prescribed drugs in both adults and children.

• They increase water and sodium excretion, reducing fluid overload.

What is New:

• This article reviews indications, mechanisms of action, side effects, and basic pharmacokinetics facts on diuretics in Paediatrics.

• It also addresses current issues, like the management of diuretic resistance, the recent controversy on hydrochlorothiazide, and the novel classes vaptans and gliflozins.

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Funding

Dr. Lava is the current recipient of research grants from Fonds de perfectionnement, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Fondation SICPA, Prilly, Switzerland; Fondazione Dr. Ettore Balli, Bellinzona, Switzerland; Fondazione per il bambino malato della Svizzera italiana, Bellinzona, Switzerland, and Frieda Locher-Hofmann Stiftung, Zürich, Switzerland. Dr. Schaffner is the current recipient of training grants from Fonds de perfectionnement, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland, and Fondation SICPA, Prilly, Switzerland.

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Author notes

  1. Sebastiano A. G. Lava and Chiara Zollinger contributed equally to this work.

Authors and Affiliations

  1. Pediatric Cardiology, Women-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Sebastiano A. G. Lava, Chiara Zollinger, Damien Schaffner, Nicole Sekarski & Stefano Di Bernardo

  2. Heart Failure and Transplantation, Department of Paediatric Cardiology, Great Ormond Street Hospital, London, UK

    Sebastiano A. G. Lava

  3. Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland

    Sebastiano A. G. Lava

  4. Pediatric Nephrology, Women-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Hassib Chehade

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  1. Sebastiano A. G. Lava
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  2. Chiara Zollinger
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  4. Damien Schaffner
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Contributions

SAGL and SDB conceptualized and designed the study. CZ, supervised by SAGL, performed the literature search. SAGL contributed to data interpretation and critically analyzed and summarized the data. SAGL drafted the initial manuscript. SAGL, CZ, HC, DS, NS, and SDB critically reviewed the manuscript. All authors approved the final manuscript as submitted.

Corresponding author

Correspondence to Sebastiano A. G. Lava.

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Communicated by Gregorio Milani

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Lava, S.A.G., Zollinger, C., Chehade, H. et al. Diuretics in pediatrics. Eur J Pediatr 182, 2077–2088 (2023). https://doi.org/10.1007/s00431-022-04768-2

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