Urine formation begins with the ultrafiltration of blood at the glomerulus. None of the available diuretics exerts its effects by altering the rate of glomerular filtration. Some agents, discussed later, reduce the glomerular filtration rate (GFR). However, this generally is an unde-sired or adverse reaction. Furthermore, at reduced GFRs, the delivery of sodium to the loop of Henle and the distal convoluted tubule, where the most efficacious classes of diuretics act, may be sufficiently compromised to reduce the action of the drugs. Understanding the
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