Diuretics: pharmacological basis of clinical effects

Regulation of water-salt metabolism is complex and is determined by many factors. Diuretics have affinity for renal tissue and limit the reabsorption of sodium ions in the nephron and secondarily reduce the reabsorption and secretion of other ions and water. Classifications of diuretics are given, the mechanisms of their action are considered, and the main indications for use are listed, taking into are indicated, taking into account the newly discovered mechanisms, contraindications and side effects are listed. Attention is focused on the use of drugs of other groups that have a diuretic effect. Gliflozins - blockers of sodium-glucose cotransporter-2 type, are promising drugs for overcoming resistance to diuretics. Vaptans inhibit membrane aquaporin transporter proteins (AQPs), are coupled to vasopressin receptors, and reduce water reabsorption in collecting tubules without affecting natriuresis. Vasopressin receptor blockade accelerates the elimination of fluid from the body and improves the symptoms and signs of CHF with short-term use. The diuretic effect can be caused by lithium by a sharp decrease in AQP-2 in the apical membrane of the collecting tubules. Screening of new diuretics involves further study of pendrin inhibitors as monotherapy and in combination with known diuretics. Screening of new diuretics involves further study of pendrin inhibitors in the form of monotherapy and in combination with known diuretics. Prospects for the development of diuretics are outlined. In modern practice, both classical diuretics and new drugs with an additional diuretic effect and a number of pleiotropic properties, including cardio- and nephroprotection, are used. The action of classical diuretics is not limited to the diuretic effect. They have been proven to improve the prognosis in patients with chronic heart failure and chronic kidney disease, form the basis for the treatment of ascites in cirrhosis of the liver, facilitate the achievement of target blood pressure values and reduce cardiovascular risks as part of combination therapy, and are effective in glaucoma.