Misplaced Pages

#935064

64-595: Furosemide , sold under the brand name Lasix among others, is a loop diuretic medication used to treat edema due to heart failure , liver scarring , or kidney disease . Furosemide may also be used for the treatment of high blood pressure . It can be taken intravenously or orally . When given intravenously, furosemide typically takes effect within five minutes; when taken orally, it typically metabolizes within an hour. Common side effects include orthostatic hypotension (decrease in blood pressure while standing, and associated lightheadedness ), tinnitus (ringing in

128-434: A glomerular filtration rate (GFR) of less than 15 or the need for renal replacement therapy . It is also equivalent to stage 5 chronic kidney disease . Treatment of acute failure depends on the underlying cause. Treatment of chronic failure may include hemodialysis , peritoneal dialysis , or a kidney transplant . Hemodialysis uses a machine to filter the blood outside the body. In peritoneal dialysis specific fluid

192-512: A metabolic alkalosis due to hypochloremia and hypokalemia . The drug should, therefore, not be used in horses that are dehydrated or experiencing kidney failure. It should be used with caution in horses with liver problems or electrolyte abnormalities. Overdose may lead to dehydration, change in drinking patterns and urination, seizures, gastrointestinal problems, kidney damage, lethargy, collapse, and coma. Furosemide should be used with caution when combined with corticosteroids (as this increases

256-399: A low volume of distribution. The protein bound nature of the loop diuretic molecules causes it to be secreted via several transporter molecules along the luminal wall of the proximal convoluted tubules to be able to exert its function. Loop diuretics usually have a ceiling effect whereby doses greater than a certain maximum amount will not increase the clinical effect of the drug. Also, there

320-521: A race. In the United States of America, pursuant to the racing rules of most states, horses that bleed from the nostrils ( exercise-induced pulmonary hemorrhage ) three times are permanently barred from racing. Sometime in the early 1970s, furosemide's ability to prevent, or at least greatly reduce, the incidence of bleeding by horses during races was discovered accidentally. Clinical trials followed, and by decade's end, racing commissions in some states in

384-439: A renal failure index (RFI) greater than 3 are helpful in confirming acute renal failure. Those with end stage renal failure who undergo haemodialysis have higher risk of spontaneous intra-abdominal bleeding than the general population (21.2%) and non-occlusive mesenteric ischemia (18.1%). Meanwhile, those undergoing peritoneal dialysis have a higher chance of developing peritonitis and gastrointestinal perforation . However,

448-476: A variety of causes, generally classified as prerenal , intrinsic , and postrenal . Many people diagnosed with paraquat intoxication experience AKI, sometimes requiring hemodialysis . The underlying cause must be identified and treated to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these fundamental causes. Chronic kidney disease (CKD) can also develop slowly and, initially, show few symptoms. CKD can be

512-575: Is a known ototoxic agent generally causing transient hearing loss but can be permanent. Reported cases of furosemide induced hearing loss appeared to be associated with rapid intravenous administration, high dosages, concomitant renal disease and coadministration with other ototoxic medication. However, a recently reported longitudinal study showed that participants treated with loop diuretics over 10 years were 40% more likely to develop hearing loss and 33% more likely of progressive hearing loss compared to participants who did not use loop diuretics. This suggests

576-722: Is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as either acute kidney failure , which develops rapidly and may resolve; and chronic kidney failure , which develops slowly and can often be irreversible. Symptoms may include leg swelling , feeling tired, vomiting , loss of appetite, and confusion . Complications of acute and chronic failure include uremia , hyperkalemia , and volume overload . Complications of chronic failure also include heart disease , high blood pressure , and anaemia . Causes of acute kidney failure include low blood pressure , blockage of

640-444: Is a theoretical risk that patients sensitive to sulfonamides may be sensitive to these loop diuretics. This risk is stated on drug packaging inserts. However, the actual risk of crossreactivity is largely unknown and there are some sources that dispute the existence of such cross reactivity. In one study it was found that only 10% of patients with allergy to antibiotic sulfonamides were also allergic to diuretic sulfonamides, but it

704-409: Is a threshold minimum concentration of loop diuretics that needs to be achieved at the thick ascending limb to enable the onset of abrupt diuresis. The availability of furosemide is highly variable, ranging from 10% to 90%. The biological half-life of furosemide is limited by absorption from the gastrointestinal tract into the bloodstream. The apparent half-life of its excretion is higher than

SECTION 10

#1732892144936

768-456: Is achieved by competing for the Cl binding site. Loop diuretics also inhibit NKCC2 at macula densa , reducing sodium transported into macula densa cells. This stimulates the release of renin , which through renin–angiotensin system , increases fluid retention in the body, increases the perfusion of glomerulus , thus increasing glomerular filtration rate (GFR). At the same time, loop diuretics inhibit

832-468: Is adjusted to produce 3 to 5 litres of urine per day. Thiazide (blockade of sodium-chloride symporter), amiloride (blockade of epithelial sodium channels) and carbonic anhydrase inhibitors (blockade of chloride-bicarbonate exchanger pendrin) has been suggested to complement the action of loop diuretics in resistance cases but limited evidence are available to support their use. The most common adverse drug reactions (ADRs) are dose-related and arise from

896-476: Is another well-known cause of chronic failure. The majority of people affected with polycystic kidney disease have a family history of the disease. Systemic lupus erythematosus (SLE) is also a known cause of chronic kidney failure. Other genetic illnesses cause kidney failure, as well. Overuse of common drugs such as ibuprofen , and acetaminophen (paracetamol) can also cause chronic kidney failure. Some infectious disease agents, such as hantavirus , can attack

960-479: Is associated with poor outcomes including higher risk of kidney function decline, hospitalization, and death. A recent PCORI -funded study of patients with kidney failure receiving outpatient hemodialysis found similar effectiveness between nonpharmacological and pharmacological treatments for depression. In the United States, acute failure affects about 3 per 1,000 people a year. Chronic failure affects about 1 in 1,000 people with 3 per 10,000 people newly developing

1024-560: Is believed to be the release into the bloodstream of muscle breakdown products – notably myoglobin , potassium , and phosphorus – that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions). The specific action on the kidneys is not fully understood, but may be due in part to nephrotoxic metabolites of myoglobin. Chronic kidney failure has numerous causes. The most common causes of chronic failure are diabetes mellitus and long-term, uncontrolled hypertension . Polycystic kidney disease

1088-478: Is clinically equivalent to a 20   mg dose of torsemide and to a 1   mg dose of bumetanide. Loop diuretics are principally used in the following indications: The 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guidelines stated that diuretics should not be used to treat acute kidney injury, except for the management of volume overload. Diuretics has not shown any benefits of preventing or treating acute kidney injury. They are also sometimes used in

1152-450: Is considered a severe illness and requires some form of renal replacement therapy ( dialysis ) or kidney transplant whenever feasible. A normal GFR varies according to many factors, including sex, age, body size and ethnic background. Renal professionals consider the glomerular filtration rate (GFR) to be the best overall index of kidney function. The National Kidney Foundation offers an easy to use on-line GFR calculator for anyone who

1216-663: Is differentiated by the trend in the serum creatinine ; other factors that may help differentiate acute kidney failure from chronic kidney failure include anemia and the kidney size on sonography as chronic kidney disease generally leads to anemia and small kidney size. Acute kidney injury (AKI), previously called acute renal failure (ARF), is a rapidly progressive loss of renal function , generally characterized by oliguria (decreased urine production, quantified as less than 400  mL per day in adults, less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance . AKI can result from

1280-434: Is interested in knowing their glomerular filtration rate. (A serum creatinine level, a simple blood test, is needed to use the calculator.) Before the advancement of modern medicine, renal failure was often referred to as uremic poisoning. Uremia was the term for the contamination of the blood with urea. It is the presence of an excessive amount of urea in blood. Starting around 1847, this included reduced urine output, which

1344-456: Is measured in five stages, which are calculated using the person's GFR, or glomerular filtration rate . Stage 1 CKD is mildly diminished renal function, with few overt symptoms. Stages 2 and 3 need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. People with stage 4 and 5 kidney failure usually require preparation towards active treatment in order to survive. Stage 5 CKD

SECTION 20

#1732892144936

1408-431: Is placed into the abdominal cavity and then drained, with this process being repeated multiple times per day. Kidney transplantation involves surgically placing a kidney from someone else and then taking immunosuppressant medication to prevent rejection . Other recommended measures from chronic disease include staying active and specific dietary changes. Depression is also common among patients with kidney failure, and

1472-514: Is restricted by most equestrian organizations. US major racetracks ban the use of furosemide on race days. Loop diuretic Loop diuretics are 90% bonded to proteins and are secreted into the proximal convoluted tubule through organic anion transporter 1 (OAT-1), OAT-2, and ABCC4 . Loop diuretics act on the Na -K -2Cl symporter (NKCC2) in the thick ascending limb of the loop of Henle to inhibit sodium, chloride and potassium reabsorption. This

1536-718: Is the INN and BAN . The previous BAN was frusemide. Brand names under which furosemide is marketed include: Aisemide, Apo-Furosemide, Beronald, Desdemin, Discoid, Diural, Diurapid, Dryptal, Durafurid, Edemid, Errolon, Eutensin, Farsiretic, Flusapex, Frudix, Frusemide, Frusetic, Frusid, Fulsix, Fuluvamide, Furantril, Furesis, Furix, Furo-Puren, Furon, Furosedon, Fusid.frusone, Hydro-rapid, Impugan, Katlex, Lasilix, Lasix, Lodix, Lowpston, Macasirool, Mirfat, Nicorol, Odemase, Oedemex, Profemin, Rosemide, Rusyde, Salix, Seguril, Teva-Furosemide, Trofurit, Uremide, and Urex. The diuretic effects are put to use most commonly in horses to prevent bleeding during

1600-426: Is the crush syndrome , when large amounts of toxins are suddenly released in the blood circulation after a long compressed limb is suddenly relieved from the pressure obstructing the blood flow through its tissues, causing ischemia . The resulting overload can lead to the clogging and the destruction of the kidneys. It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism

1664-457: Is to increase the production of prostaglandins , which results in vasodilation and increased blood supply to the kidney. Prostaglandin-mediated vasodilation of preglomerular afferent arterioles increases the glomerular filtration rate (GFR) and facilitates diuresis. The collective effects of decreased blood volume and vasodilation help decrease blood pressure and ameliorate edema . Loop diuretics are highly protein bound and therefore have

1728-458: Is unclear if this represents true cross reactivity or the nature of being prone to allergy. Ethacrynic acid is the only medication of this class that is not a sulfonamide. It carries a greater risk of reversible or permanent hearing loss (ototoxicity), and has a distinct complication of being associated with gastrointestinal toxicity. Kidney failure Kidney failure , also known as renal failure or end-stage renal disease ( ESRD ),

1792-414: The potassium-sparing diuretic amiloride ( Co-amilofruse ). Other electrolyte abnormalities that can result from furosemide use include hyponatremia, hypochloremia, hypomagnesemia, and hypocalcemia. In the treatment of heart failure, many studies have shown that the long-term use of furosemide can cause varying degrees of thiamine deficiency , so thiamine supplementation is also suggested. Furosemide

1856-500: The tubuloglomerular feedback mechanism so that increase in salts at the lumen near macula densa does not trigger a response that reduces the GFR. Loop diuretics also inhibit magnesium and calcium reabsorption in the thick ascending limb. Absorption of magnesium and calcium are dependent upon the positive voltage at the luminal side and less positive voltage at the interstitial side with transepithelial voltage gradient of 10 mV. This causes

1920-409: The urinary tract , certain medications, muscle breakdown , and hemolytic uremic syndrome . Causes of chronic kidney failure include diabetes , high blood pressure , nephrotic syndrome , and polycystic kidney disease . Diagnosis of acute failure is often based on a combination of factors such as decreased urine production or increased serum creatinine . Diagnosis of chronic failure is based on

1984-566: The USA began legalizing its use on race horses. In 1995, New York became the last state in the United States to approve such use, after years of refusing to consider doing so. Some states allow its use for all racehorses; some allow it only for confirmed "bleeders". Its use for this purpose is still prohibited in many other countries. Furosemide is also used in horses for pulmonary edema, congestive heart failure (in combination with other drugs), and allergic reactions. Although it increases circulation to

Furosemide - Misplaced Pages Continue

2048-525: The United States, it is available as a generic medication . In 2022, it was the 24th most commonly prescribed medication in the United States, with more than 23   million prescriptions. In 2020/21 it was the twentieth most prescribed medication in England. It is on the World Anti-Doping Agency 's banned drug list due to concerns that it may mask other drugs. It has also been used in race horses for

2112-401: The apparent half-life of absorption via the oral route. Therefore, furosemide taken intravenously is twice as potent as an equivalent dose taken orally. However, for torsemide and bumetanide, their oral bioavailability is consistently higher than 90%. Torsemide has a longer half life in heart failure patients (6   hours) than furosemide (2.7   hours). A 40   mg dose of furosemide

2176-481: The blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute kidney injury include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure. Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, along with bee stings may also cause

2240-409: The brain or lungs where rapid diuresis is required ( IV injection), and in the management of severe hypercalcemia in combination with adequate rehydration. In chronic kidney diseases with hypoalbuminemia , furosemide is used along with albumin to increase diuresis. It is also used along with albumin in nephrotic syndrome to reduce edema. Furosemide is mainly excreted by tubular secretion in

2304-441: The condition each year. In Canada, the lifetime risk of kidney failure or end-stage renal disease (ESRD) was estimated to be 2.66% for men and 1.76% for women. Acute failure is often reversible while chronic failure often is not. With appropriate treatment many with chronic disease can continue working. Kidney failure can be divided into two categories: acute kidney failure or chronic kidney failure . The type of renal failure

2368-519: The delivery of diuretic molecules into the nephron, limiting sodium excretion and increasing sodium retention, causing diuretic resistance. Non-steroidal anti-inflammatory drug (NSAID) can compete with loop diuretics for organic ion transporters, thus preventing the diuretic molecules from being secreted into the proximal convoluted tubules. Those with diuretic resistance, cardiorenal syndrome, and severe right ventricular dysfunction may have better response to continuous diuretic infusion. Diuretic dosages

2432-406: The ears), and photosensitivity (sensitivity to light). Potentially serious side effects include electrolyte abnormalities , low blood pressure , and hearing loss . It is recommended that serum electrolytes (especially potassium ), serum CO 2 , creatinine , BUN levels, and liver and kidney functioning be monitored in patients taking furosemide. It is also recommended to be alert for

2496-563: The effect of loop diuretics on diuresis and electrolyte balance. Common ADRs include: hyponatremia , hypokalemia , hypomagnesemia , dehydration , hyperuricemia , gout , dizziness , postural hypotension , syncope . The loss of magnesium as a result of loop diuretics has also been suggested as a possible cause of pseudogout ( chondrocalcinosis ). Infrequent ADRs include: dyslipidemia , increased serum creatinine concentration, hypocalcemia, rash . Metabolic alkalosis may also be seen with loop diuretic use. Ototoxicity (damage to

2560-445: The generation of a hypertonic renal medulla . Without such a concentrated medulla, water has less of an osmotic driving force to leave the collecting duct system , ultimately resulting in increased urine production. Loop diuretics cause a decrease in the renal blood flow by this mechanism. This diuresis leaves less water to be reabsorbed into the blood, resulting in a decrease in blood volume. A secondary effect of loop diuretics

2624-468: The goal of treatment, as with AKI, is to return the person to baseline kidney function, typically measured by serum creatinine . Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if the person has not been monitored by a physician and no baseline (i.e., past) blood work is available for comparison. Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When

Furosemide - Misplaced Pages Continue

2688-423: The inner ear) is a serious, but rare ADR associated with use of loop diuretics. This may be limited to tinnitus and vertigo , but may result in deafness in serious cases. Loop diuretics may also precipitate kidney failure in patients concurrently taking an NSAID and an ACE inhibitor —the so-called "triple whammy" effect. Because furosemide, torsemide and bumetanide are technically sulfa drugs, there

2752-431: The kidney. In kidney impairment, clearance is reduced, increasing the risk of adverse effects. Lower initial doses are recommended in older patients (to minimize side-effects) and high doses may be needed in kidney failure . It can also cause kidney damage; this is mainly by loss of excessive fluid (i.e., dehydration), and is usually reversible. Furosemide acts within 1 hour of oral administration (after IV injection,

2816-512: The kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia . Very low levels of azotemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Kidney failure accompanied by noticeable symptoms is termed uraemia . Symptoms of kidney failure include the following: Acute kidney injury (previously known as acute renal failure) – or AKI – usually occurs when

2880-675: The kidneys, causing kidney failure. The APOL1 gene has been proposed as a major genetic risk locus for a spectrum of nondiabetic renal failure in individuals of African origin, these include HIV-associated nephropathy (HIVAN), primary nonmonogenic forms of focal segmental glomerulosclerosis , and hypertension affiliated chronic kidney disease not attributed to other etiologies. Two western African variants in APOL1 have been shown to be associated with end stage kidney disease in African Americans and Hispanic Americans. Chronic kidney failure

2944-560: The kidneys, it does not help kidney function, and is not recommended for kidney disease. It is also used to treat congestive heart failure (pulmonary edema, pleural effusion, and/or ascites) in cats and dogs. Furosemide is injected either intramuscularly or intravenously , usually 0.5-1.0 mg/kg twice/day, although less before a horse is raced. As with many diuretics, it can cause dehydration and electrolyte imbalance , including loss of potassium , calcium , sodium , and magnesium . Excessive use of furosemide will most likely lead to

3008-437: The large NaCl absorptive capacity of the loop of Henle, diuresis is not limited by development of acidosis, as it is with the carbonic anhydrase inhibitors. Additionally, furosemide is a noncompetitive subtype-specific blocker of GABA-A receptors. Furosemide has been reported to reversibly antagonize GABA-evoked currents of α 6 β 2 γ 2 receptors at μM concentrations, but not α 1 β 2 γ 2 receptors. During development,

3072-508: The long term consequence of irreversible acute disease or part of a disease progression. CKD is divided into 5 different stages (1–5) according to the estimated glomerular filtration rate (eGFR). In CKD1 eGFR is normal and in CKD5 eGFR has decreased to less than 15 ml/min. Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). The acute part of AoCRF may be reversible, and

3136-475: The long-term consequences of loop diuretics on hearing could be a more significant than previously thought and further research is required in this area.   Other precautions include: nephrotoxicity, sulfonamide (sulfa) allergy, and increases free thyroid hormone effects with large doses. Furosemide has potential interactions with these medications: Potentially hazardous interactions with other drugs: Furosemide, like other loop diuretics, acts by inhibiting

3200-505: The luminal Na–K–Cl cotransporter in the thick ascending limb of the loop of Henle , by binding to the Na-K-2Cl transporter, thus causing more sodium, chloride, and potassium to be excreted in the urine. The action on the distal tubules is independent of any inhibitory effect on carbonic anhydrase or aldosterone; it also abolishes the corticomedullary osmotic gradient and blocks negative, as well as positive, free water clearance . Because of

3264-435: The magnesium and calcium ions to be repelled from luminal side to interstitial side, promoting their absorption. The difference in voltage in both sides is set up by potassium recycling through renal outer medullary potassium channel . By inhibiting the potassium recycling, the voltage gradient is abolished and magnesium and calcium reabsorption are inhibited. By disrupting the reabsorption of these ions, loop diuretics prevent

SECTION 50

#1732892144936

3328-414: The management of severe hypercalcemia in combination with adequate rehydration. Diuretic resistance is defined as failure of diuretics to reduce fluid retention (can be measured by low urinary sodium) despite using the maximal dose of drugs. There are various causes for the resistance towards loop diuretics. After initial period of diuresis, there will be a period of "post-diuretic sodium retention" where

3392-467: The number of distal convoluted cells, principle cells, and intercalated cells. These cells have sodium-chloride symporter at distal convoluted tubule, epithelial sodium channels, and chloride-bicarbonate exchanger pendrin. This will promote sodium reabsorption and fluid retention, causing diuretic resistance. Other factors includes gut edema which slows down the absorption of oral loop diuretics. Chronic kidney disease (CKD) reduces renal flow rate, reducing

3456-509: The occurrence of any potential blood dyscrasias . Furosemide is a type of loop diuretic that works by decreasing the reabsorption of sodium by the kidneys. Common side effects of furosemide injection include hypokalemia (low potassium level), hypotension (low blood pressure), and dizziness. Furosemide was patented in 1959 and approved for medical use in 1964. It is on the World Health Organization's List of Essential Medicines . In

3520-407: The onset of acute kidney injury. Unlike chronic kidney disease, however, the kidneys can often recover from acute kidney injury, allowing the person with AKI to resume a normal life. People with acute kidney injury require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure. Among the accidental causes of renal failure

3584-456: The peak effect is within 30 minutes). Diuresis is usually complete within 6–8 hours of oral administration, but there is significant variation between individuals. Furosemide also can lead to gout caused by hyperuricemia . Hyperglycemia is also a common side effect. The tendency, as for all loop diuretics, to cause low serum potassium concentration ( hypokalemia ) has given rise to combination products, either with potassium or with

3648-712: The rate of acute pancreatitis does not differ from the general population. The treatment of acute kidney injury depends on the cause. The treatment of chronic kidney failure may include renal replacement therapy: hemodialysis , peritoneal dialysis , or kidney transplant . In non-diabetics and people with type 1 diabetes , a low protein diet is found to have a preventive effect on progression of chronic kidney disease. However, this effect does not apply to people with type 2 diabetes . A whole food, plant-based diet may help some people with kidney disease. A high protein diet from either animal or plant sources appears to have negative effects on kidney function at least in

3712-516: The rate of sodium excretion does not reach as much as the initial diuresis period. Increase intake of sodium during this period will offset the amount of excreted sodium, and thus causing diuretic resistance. Prolonged usage of loop diuretics will also contributes to resistance through "braking phenomenon". This is the body physiological response to reduced extracellular fluid volume, where renin-angiotensin-aldosterone system will be activated which results in nephron remodelling. Nephron remodeling increases

3776-453: The rates of rehospitalisation associated with heart failure, with no difference in risk of death. Torsemide may also be safer than furosemide. Providing self-administered subcutaneous furosemide has been found to reduce hospital admissions in people with heart failure, resulting in significant savings in healthcare costs. Furosemide is also used for liver cirrhosis , kidney impairment , nephrotic syndrome , in adjunct therapy for swelling of

3840-416: The risk of digoxin toxicity due to hypokalemia. It is recommended that furosemide not be used during pregnancy or in a lactating mare, as it has been shown to be passed through the placenta and milk in studies with other species. It should not be used in horses with pituitary pars intermedia dysfunction (Equine Cushing's Disease). Furosemide is detectable in urine 36–72 hours following injection. Its use

3904-447: The risk of electrolyte imbalance), aminoglycoside antibiotics (increases risk of kidney or ear damage), and trimethoprim sulfa (causes decreased platelet count). It may also cause interactions with anesthetics, so its use should be related to the veterinarian if the animal is going into surgery, and it decreases the kidneys' ability to excrete aspirin , so dosages will need to be adjusted if combined with that drug. Furosemide may increase

SECTION 60

#1732892144936

3968-541: The treatment and prevention of exercise-induced pulmonary hemorrhage . Furosemide is primarily used for the treatment of edema , but also in some cases of hypertension (where there is also kidney or heart impairment). It is often viewed as a first-line agent in most people with edema caused by congestive heart failure because of its anti-vasoconstrictor and diuretic effects. Compared with furosemide, however, torasemide (aka "torsemide") has been demonstrated to show improvements to heart failure symptoms, possibly lowering

4032-416: The α 6 β 2 γ 2 receptor increases in expression in cerebellar granule neurons, corresponding to increased sensitivity to furosemide. The pharmacokinetics of furosemide are apparently not significantly altered by food. No direct relationship has been found between furosemide concentration in the plasma and furosemide efficacy. Efficacy depends upon the concentration of furosemide in urine. Furosemide

4096-436: Was thought to be caused by the urine mixing with the blood instead of being voided through the urethra. The term uremia is now used for the illness accompanying kidney failure. Two other urinary indices, are the fractional sodium excretion (FENa) index and the renal failure index (RFI). The renal failure index is equal to urine sodium times plasma creatinine divided by urine creatinine . A FENa score greater than 3% or

#935064