kidney failure and diuretics

[Pharmguru]

But diuretics would make you more dehydrated so how would you counter than in a patient on say furosemide for renal failure

[Nik]

Ok - seems to me like we're going around in circles here ! If someone is in renal failure then diuretic use should always be rationalised to ensure that there is an appropriate indication. If diuretic use is deemed essential, then patients should be kept well hydrated where possible. As I have mentioned previously a balance needs to be struck between renal function and continued diuretic use, and symptoms for which the diuretic is being used. A compromise may have to be reached in terms of drug dosing and what the patient can tolerate. It's at these times that more specialist advice be sought i.e nephrologists. I am not an expert on kidney disease unfortunately and if you ever encounter such a patient in practice then you will not be expected to be one either.

[Asterix]

what do people think of long term use of nsaids and diuretics. seems to be on a lot of kardexs I have seen recently

[Asterix]

read the previous posts nik- why not go for bumetanide

[Nik]

Perhaps there's more experience with using furosemide in these situations. Dose is easier to manipulate whether IV or oral as well.

[Asterix]

Perhaps there's more experience with using furosemide in these situations. Dose is easier to manipulate whether IV or oral as well.

bumetanide is much more powerful though, a lot more than furo

[Nik]

I don't know about it being more potent - I've worked along the equivalence of 1mg bumetanide is approx equivalent to 40mg furosemide.

[Asterix]

Bumetanide is 40 times more potent than furosemide (for patients with normal renal function) from goodman and gilman textbook

[johnep]

Another factor is gut oedema. If this is present, then Bumetanide much better absorbed. One of the pointers is lack of appetite. If this improves on Bumetanide, then shows possible gut oedema. In these circumstances, initial dose of Bumetanide should be lower than 1:40.
Ie if pt has been on 200mg+ Frusemide, start with 5mg Bumetanide and titrate as necessary.
johnep