Use of diuretics in cirrhosis and nephrotic syndrome

Patients with cirrhosis and with nephrotic syndrome have subnormal responses to diuretics. The mechanism of this effect in cirrhosis is decreased pharmacodynamics of response. Large doses of diuretic are not useful in this setting. Instead, more frequent administration of modest doses is required. In nephrotic syndrome, substantial amounts of diuretic are rendered inactive by binding to urinary albumin, thereby mandating larger doses. In addition, the pharmacodynamics of response are altered so that doses must be administered more frequently. Rarely, patients may benefit from combinations of albumin and a loop diuretic.