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. The principal site of action of this class of diuretics is the thick ascending limb of the loop of Henle after secretion in the proximal tubules, hence the term 'loop diuretics'. A reversible inhibition of the salt reabsorption transporter is induced when loop diuretics are present in the tubular lumen of the nephrons. The inhibition of Na + and Cl- reabsorption increases the load of the distal tubules, eventually inducing natriuresis and secondary diuresis.

Thus delivery of the diuretic to the tubular lumen is essential for these pharmacological effects ( Wittner et al 1991). Following active secretion in the proximal tubule, loop diuretics gain access to this site along the non-specific transport route for organic acid. Calciuria is also induced.

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