[Loop-diuretics anno 1992. Mechanisms of effect and current therapeutic principles]

Loop-diuretics inhibit the Na+/K+/2Cl(-) -cotransport system in the thick ascending loop of Henle, and are the most potent of the diuretic agents. They also increase production of prostaglandins and, when given intravenously, reduce pulmonary capillary pressure. The clinical effects, and side effects, of loop diuretics are reviewed. In Norway, use of thiazide diuretics has declined, but use of loop-diuretics has remained unchanged. Loop-diuretics are still first-line drugs in cases of heart failure. The author discusses treatment of patients resistant to conventional doses of diuretics, and the causes of the resistance. Since furosemide and bumetanide may have very different effects and side effects, both are needed as treatment alternatives.