Inexpensive diuretics for edema

Diuretics (diuretics) - the means forimprove the separation of urine. They are used to reduce the swelling of the tissues (with heart failure, cirrhosis of the liver), the walls of the vessels (with hypertension and symptomatic arterial hypertension), reduce intracranial pressure (with increased pressure of cerebrospinal fluid), and kidney disease.

Edema syndrome manifests itself:
1) visible edema: on the face with kidney diseases, on the legs and anterior abdominal wall with heart failure and cirrhosis of the liver, on the legs with diseases of the veins;
2) concealed edema, the manifestations of which canbe abnormally fast (within days) weight gain or shortness of breath during physical exertion and even at rest. Hidden edema is revealed by the following tests: McClure-Aldrich test (the rate of resorption of physiological solution injected intradermally), a positive ring symptom (stiffness of the ring on the finger ), an ankle joint increase more than 1 cm per week, a measurement of the daily volume of excreted urine (increase of a night portion by more than 75 ml and a decrease in daily release by more than 150 ml), weight gain after a week th a 250-300 g

The causes of edema are kidney diseases (acuteand chronic glomerulonephritis, interstitial nephritis) and cardiovascular system (heart failure, varicose leg disease), liver disease (cirrhosis, hepatic vein damage), endocrine system diseases (hypothyroidism, diabetes mellitus), pregnancy, alimentary dystrophy, oncological diseases.
In any case, the presence of edema should becomean occasion for the prompt reference to the doctor with the purpose of revealing the reason of their occurrence. Complex treatment of the underlying disease should be carried out, and not only the elimination of edema, which is, in fact, only a consequence.
A huge mistake is receiving yourselfselected diuretics. Many of them wash potassium out of the body, so they require simultaneous intake of potassium preparations. Otherwise, the outcome may be a severe heart failure with a decline in quality of life and an unfavorable prognosis. On the other hand, taking potassium drugs in combination with potassium-sparing diuretics can lead to arrhythmias.

The action of diuretics is determined by theirinfluence on a unit of the structure of the kidneys - nephron. The nephron consists of a vascular glomerulus, its capsules and the tubule system. The tubules are divided into the proximal, which passes into the nephron loop and distal, through which the urine from the nephron passes into the collecting tubules, then into the renal pelvis, from which it enters the bladder through the ureters.
In the glomerulum there is a filtration of blood plasma fromcapillaries into the cavity of the capsule. Reverse absorption of water (reabsorption) occurs throughout the nephron. In the tubules, in addition to water, sodium, potassium and chlorine ions are absorbed.

Currently, diuretics are divided into three groups: saluretics, potassium-sparing, osmotic diuretics.
1) Saluretics:
- derivatives of thiazide (hydrochlorothiazide, cyclomethiazide);
- loop diuretics (furosemide, torasemide, bumetanide, ethacrynic acid);
- sulfonamides (chlorthalidone, clopamid, indapamide);
- inhibitors of carbonic anhydrase (diacarb).
The main mechanism of action of saluretics -elimination of sodium and potassium ions. Loop diuretics are more powerful than thiazide ones. The ions of sodium and chlorine are predominantly derived. Inhibitors of carbonic anhydrase cause a diuretic effect due to an increase in the release of kidney ions of sodium, potassium, bicarbonates and carbonic acid.
2) Potassium-sparing diuretics triamterene, amiloride, spironolactone, eplerenone.
The resources of this group work at the level ofdistal tubule. They all prevent potassium loss, only the mechanisms of action are different: amiloride and triamterene (triampur) suppress potassium loss, and spironolactone (veroshpiron) has an effect opposite to aldosterone (hormone of the adrenal cortex), which causes a delay in the body of sodium chloride, and after him water.
3) Osmotic diuretics (mannitol, urea). The mechanism of their action is based on increasing the osmotic pressure in the tubules, preventing the reverse absorption of water.
By the speed of the onset of a diuretic effect, diuretics are divided into:
1. Rapid action (effect after 30-40 minutes): furosemide, torasemide, mannitol, urea, ethacrynic acid, triamterene.
2. Intermediate (2-4 hours): Diacarb, amiloride, clopamid, chlorthalidone.
3. Slow action (2-4 days): spironolactone (veroshpiron), eplerenone.
By the duration of diuretic action, diuretics are divided into:
1. Diuretic short-acting (4-8 hours): furosemide, torasemide, mannitol, urea, ethacrynic acid.
2. Medium duration (8-14 hours): triamterene, diacarb, hydrochlorothiazide, clopamid, indapamide.
3. Prolonged action (up to 4 days): chlortalidone, eplerenone, spironolactone.
By force of action distinguish:
1. Strong diuretics: furosemide (Lasix), torasemide (triphas), ethacrynic acid (uretit), clopamide (brinaldix), mannitol, urea.
2. Diuretics of medium strength: thiazide diuretics - hydrochlorothiazide (hypothiazide, dichlorothiazide), cyclomethiazide, chlortalidone (hygroton, oxodoline).
3. Weak diuretics: spironolactone (veroshpiron, aldactone), diacarb (acetazolamide), amiloride, triamterene (pterofen).
The drugs of choice for various diseases are:
loop diuretics for chronic cardiacinsufficiency, renal insufficiency; thiazide diuretics in osteoporosis; indapamide in metabolic disorders; veroshpiron with increased secretion of the adrenal glands of aldosterone; Diakarb with increased intracranial pressure; Thiazide diuretics and indapamide with arterial hypertension.

Widely used drugsmedicinal plants (leaves bearberry, cowberry, birch buds), which have a weak diuretic effect, are currently not used as diuretics.
Diuretics, which are organic compounds of mercury (merkuzal, promeran), today have a sharply limited application.

INSTRUCTION for the medical use of the drug FUROSEMID