Renal Drug List

Acetazolamide

Mechanism: inhibits CA leading to decreased H+ secretion in PT (via NHE) causing decreased rebasorption of Na+ and HCO3-

Indications: glaucoma, acute mountain sickness

Adverse Effects: Hypokalemia, Metabolic acidosis, nephrolithiasis

Other: max decreased Na+ reabsorption = 5%

• Furosemide (Lasix)
• Bumetanide (Blimex)

Mechanism: Inhibit NKCC2 --> decreased reabsorption of Na+ and Cl- in thick AL

Indications: Edema, HTN, Acute hypercalcemia

Adverse Effects: Hypokalemia, metabolic alkalosis, hypocalcemia, hypomagnesemia, hyperuricemia, hyponatremia, hypovolemia, postural hypotension, hyperglycemia, hyperlipidemia, ototoxicity (tinnitus)

Other: maximum decreased Na+ reabsorption 25-30%, 'high ceiling diuretics'

Mechanism: Inhibit NKCC2 --> decreased reabsorption of Na+ and Cl- in thick AL

Indications: Edema, HTN, Acute hypercalcemia

• Adverse Effects: Hypokalemia, metabolic alkalosis, hypocalcemia,
• hypomagnesemia, hyperuricemia, hyponatremia, hypovolemia, postural
• hypotension, hyperglycemia, hyperlipidemia, ototoxicity (tinnitus)

Other: maximum decreased Na+ reabsorption 25-30%, 'high ceiling diuretics'

• Hydrochlorothiazide
• Chlorothalidone

Mechanism: inhibit NCC --> decreased reabsorption of Na+, Cl- in DCT

Indications: HTN, edema, Nephrolithiasis due to idiopathic hypercalciuria, nephrogenic diabetes insipidus

Adverse Effects: hypokalemia, metabolic alkalosis, hypercalcemia, hypomagnesemia, hypouricemia, hyponatremia, hypovolemia, postural hypotension, hyperglycemia, hyperlipidemia

Other: max decrease in Na+ reabsorption 5-8%

• Mechanism: inhibit NCC --> decreased reabsorption of Na+, Cl- in DCTIndications: HTN, edema, Nephrolithiasis due to idiopathic hypercalciuria, nephrogenic diabetes insipidusAdverse
• Effects: hypokalemia, metabolic alkalosis, hypercalcemia,
• hypomagnesemia, hypouricemia, hyponatremia, hypovolemia, postural
• hypotension, hyperglycemia, hyperlipidemiaOther: max decrease in Na+ reabsorption 5-8%

• Amiloride
• Triamterene
• Spironolactone

Mechanism: block ENaC --> decreased reabosrption of Na+ in CD

Indications: Edema, HTN, primary/secondary hyperaldosteronism

Adverse Effects: Hyperkalemia, Metabolic acidosis, spironolactone: endocrine side effects

Other: Max decrease in Na+ reabsorption 1-2%, most commonly used in combination therapy, alone usually used for hyperaldosteronism

Mechanism: block ENaC --> decreased reabosrption of Na+ in CD

Indications: Edema, HTN, primary/secondary hyperaldosteronism

Adverse Effects: Hyperkalemia, Metabolic acidosis, spironolactone: endocrine side effects

• Other: Max decrease in Na+ reabsorption 1-2%, most commonly used in
• combination therapy, alone usually used for hyperaldosteronism

Mechanism: inhibit binding of aldosterone to cytoplasmic minearlocorticoid receptor --> decreased reabosorption of Na+ in CD via ENaC

Indications: Edema, HTN, primary/secondary hyperaldosteronism

Adverse Effects: Hyperkalemia, Metabolic acidosis, spironolactone: endocrine side effects

• Other: Max decrease in Na+ reabsorption 1-2%, most commonly used in
• combination therapy, alone usually used for hyperaldosteronism

Mannitol

Mechanism: inhibit reabsorption of Na+, other solutes by a physiological mechanism (mainly involving PT)

Indications: rapid induction of large natiuresis and diuresis, shift of fluid from IC to EC (cerebral edema, dialysis disequilibrium syndrome, crush injuries, glaucoma)

Adverse Effects: pulmonary edema in pts with decreased LV function

Other: max decrease Na+ reabosrption 20%

• Conivaptan
• Tolvaptan
• Demeclocycline

Mechansim: block V2 receptors

Indications: hyponatremia (due to SIADH)

Adverse Effects: Hypernatremia, Dehydration

Other: Conivaptan only approved for short term IV use, Tolvaptan given orally but should be initiated in hospital)

Mechansim: block V2 receptors

Indications: hyponatremia (due to SIADH)

Adverse Effects: Hypernatremia, Dehydration

Other: Conivaptan only approved for short term IV use, Tolvaptan given orally but should be initiated in hospital)

Mechanism: decrease responsiveness of CD to ADH

Indications: Hyponatremia (due to SIADH)

Adverse Effects: Hypernatremia, Dehydration, nausea, vomiting, photosensitivity, Lithium (neuropsychiatric side effects, weight gain)