Furosemide-dependent kidney - Causes, symptoms and treatment. MF.

Currently, diseases that occur with the accumulation of excess fluid in the body are not uncommon. These are conditions such as renal failure with edema, congestive heart failure, liver disease associated with a violation of protein synthesis, as well as arterial hypertension. These diseases require the use of diuretics, in particular furosemide, for a long time and often in high doses.

Also worth mentioning are attempts to lose weight with furosemide, which is now especially common in young women. This "diet", as a rule, is characterized by thoughtless application of the drug every day, sometimes in extremely large quantities.

For such conditions, when there is a prolonged effect of furosemide on the body for medical purposes or in the process of self-treatment, the term "furosemide-dependent kidney" is introduced.

Symptoms of furosemide-dependent kidney

Furosemide is characterized by a dose-dependent effect. That is, increasing the amount of urine is achieved by applying a different amount of the drug, which is due to the underlying disease and the individual characteristics of the patient. In addition, over time, the kidneys stop responding to the initially recommended dose of the drug, and a higher dose is required. Sometimes with the withdrawal of diuretics manifest psychological changes, characteristic of the dependence on the drug. These conditions are especially pronounced in individuals who take furosemide on their own to reduce body weight.

Furosemide refers to loop diuretics( diuretics).In the kidneys( the ascending section of the Henle loop), it suppresses the reverse absorption of chloride ions, and, as a consequence, potassium, sodium and hydrogen ions, which increases the amount of urine. In addition, the drug also increases the excretion of magnesium and calcium ions from the body.

Prolonged use of furosemide can cause pseudo-Barther syndrome. This pathological condition is characterized by pronounced water-electrolyte disorders such as hypokalemia( decreased potassium concentration in the blood), hyponatremia( decrease in the concentration of sodium in the blood), hypochloremia( decrease in the chlorine concentration in the blood), alkalosis( acid-base balance disturbance,bases), signs of dehydration, increased renin activity of blood plasma.

Hypokalemia refers to hazardous conditions. In particular, it can provoke life-threatening arrhythmias, especially in high-risk patients, for example, those who underwent myocardial infarction, who take cardiac glycosides, and who have suffered from arrhythmias in the past. Potassium losses increase with the use of certain drugs. These include glucocorticoids, licorice preparations, carbenoxolone, as well as some aromatic agents in confectionery.

Symptoms of hypokalemia include muscle weakness, pain in the muscle area, a feeling of crawling, shivers, and rarely cramps. At the same time, there may be a rapid heartbeat, irregular heartbeat. Blood pressure tends to decrease. Constipation is also a manifestation of hypokalemia.

Potassium is an essential component for the synthesis of insulin. In patients with diabetes, a lack of insulin can lead to an increase in blood glucose levels, which may require a review of treatment tactics.

Magnesium deficiency causes an increase in neuromuscular excitability, and as a consequence, the occurrence of seizures and the development of cardiac arrhythmias, including atrial fibrillation, is possible.

Hyponatremia explains the headache, the change in the psyche is arousal or vice versa, a depressed state, muscle cramps, weakness and increased fatigue, nausea and vomiting that does not bring relief. These manifestations, as a rule, are associated with the development of edema of the cells of the nervous system.

Chronic fluid loss is manifested by weakness, loss of strength, abnormally low blood pressure, dizziness, drowsiness.

In the treatment of furosemide, a delay in the body of uric acid and development of gout attacks is possible.

In the treatment of furosemide, the excretion of sodium, potassium and chlorine from the body increases, which leads to the formation of metabolic alkalosis .The manifestation of alkalosis is muscle cramps, lowering of arterial pressure, pronounced general weakness, development of constipation.

In addition, furosemide as a loop diuretic enhances the ototoxicity( negative effect on hearing) of aminoglycosides and nephrotoxicity( renal tissue damage) of certain cephalosporins.

It is also necessary to mention the direct toxic effect of furosemide on kidney cells. The cases of glomerulonephritis in persons who have been using furosemide for a long time are described.

Thus, furosemide is a dangerous drug, causing a number of disorders in the body. Therefore, it should be used only under the supervision of a physician with a constant evaluation of its effectiveness, and, if necessary, with dose adjustment.

Examination of

In the treatment of furosemide, the determination of blood electrolytes( sodium, potassium, chlorine, magnesium) should be performed 3 months after the start of treatment, then the analysis is scheduled every six months.

Treatment with furosemide-dependent kidney

To prevent hypokalemia, it is recommended to increase the content of foods rich in potassium( dried apricots, nuts, raisins, peas and legumes, potatoes, especially baked in the skin, sea kale).It also shows the use of drugs with potassium, such as asparks.

Magnesium deficiency is corrected by the use of magnesium gluconate or chloride. When treating hyponatremia with sodium chloride, you must be extremely careful, since salt causes a water retention in the body.

When swallowing furosemide, swelling may worsen. This can be as a consequence of a disease for which you are prescribed furosemide, as well as dependence on furosemide( usually in cases where the diuretic was used for weight loss).In the first case, without consulting a doctor and correcting the treatment of your disease is indispensable. In the second, you can try to "get off furosemide", limiting the amount of fluid consumed against the background of taking mineral preparations of potassium and magnesium. As a diuretic for this period, use the collection of medicinal herbs. Any liquids should be taken no later than 3-4 hours a day. The last meal - no later than 6 pm. The process of getting rid of dependence is long and will take at least a month, be patient.

The World Anti-Doping Agency furosemide is prohibited for use in athletes. He himself is not doping, but as a drug that can lead to the removal of traces of other prohibited drugs by increasing the amount of urine and as a means for rapid weight loss, in the sports world is unacceptable.

Doctor therapist, nephrologist Sirotkina EV