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Golden Points

Renal Drugs

  1. Thiazides (Act on early DCT) are DOC for hypertension as they act slowly and conserve calcium (useful in osteoporosis)-they are DOC for diabetes insipidus, Liddle’s syndrome, idiopathic hypercalciuria
  2. Thiazides (Hydrochorthiazide is MC used) except metolazone & indapamide (undergo entero-hepatic circulation) are unsafe in renal failure
  3. Furosemide (Act on Loop of Hanle (Na+K+2Cl)-also called Tamm Horsfall protein) is the fastest acting (also called high ceiling diuretic)
  4. MC side effect of both thiazides & furosemide is hypokalemia; furosemide can also cause volume depletion
  5. Hypokalemia is MC precipitating factor of digoxin toxicity (hyperkalemia prevents it)
  6. Spironolactone (K+ sparing diuretic) is DOC for refractory ascites; MC side effect is hyperkalemia. Spironolactone is a prodrug, forms canrenonone and is eliminated in urine. Therefore is contraindiacated in renal failure. It does not require accesses to tubular lumen for its action. The drug acts on collecting duct to block action of aldosterone.
  7. Amiloride, triamterene are other K+ sparing diuretics; these act at late distal convoluted tubules.
  8. Mannitol is osmotic diuretic & is DOC for brain edema (not in intracerebral hemorrhage)
  9. It can cause hyperkalemia, pulmonary edema and CI in established renal failure. This is because it can cause expansion of plasma volume
  10. Demeclocycline & lithium are ADH receptor antagonists, used in syndrome of inappropriate ADH secretion (also called as anti-diuretic) 

Recent Advances 


Newer Drugs



Eplerenone (aldosterone antagonist)


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