Mechanism of action of diuretic and anti-diuretic drugs

Diuretics increase the rate of urine flow and promote sodium and water excretion acting in different segments of nephron. Among them, carbonic anhydrase inhibitors promote diuresis by inhibiting the enzyme in the proximal tubule. Loop diuretics act on Na+–K+–2Cl¯ cotransport in thick ascending limb of loop of Henle, while thiazides inhibit Na+–Cl¯ symport in early distal tubule. Aldosterone antagonists bind to mineralocorticoid receptors present on distal convoluted tubules (DCTs) and antagonize its action while renal epithelial Na+ channel inhibitors inhibit Na+ channels in DCTs and collecting ducts. Osmotic diuretics exert their actions by osmosis. The chapter provides substantial information regarding treatment of chronic kidney disease and its subset by not only thiazides and mineralocorticoid antagonists but also other class of diuretic.