Key messages

1. Loop diuretics (furosemide (frusemide) and bumetanide) are the most powerful natriuretic drugs. They increase sodium excretion and urine output even in patients with greatly reduced glomerular filtration rate.

2. Loop diuretics are prescribed to prevent oliguric acute renal failure or to render it non-oliguric.

3. Osmotic diuretics (mannitol) are pharmacologically inert drugs freely filtered in the glomerulus but poorly reabsorbed by the tubules. The mechanism of action resides in the osmotic activity that mannitol produces along the tubular segments, counteracting the normal reabsorption of sodium and water.

4. Osmotic diuretics are used as prophylactic therapy when nephron toxicity is anticipated, for example when diagnostic studies or therapeutic intervention require intravenous contrast agents, and during vascular surgery or when increased intracranial pressure is diagnosed.

5. Because of its ability to increase renal blood flow selectively through the activation of dopaminergic renal receptors, dopamine has gained in popularity for the prevention and treatment of acute renal failure. Dogma, rather than scientific proof, motivates the use of renal-dose dopamine.

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