Supra-additive natriuretic synergism between bendroflumethiazide and furosemide in rats

To examine the diuretic and natriuretic synergism between bendroflumethiazide (BFTZ) and furosemide (FUR), the acute diuretic and natriuretic response to BFTZ was compared when given alone, during acute and during chronic FUR infusion. Responses to diuretics were assessed in conscious, chronically instrumented rats and, to avoid confounding influences of diuretic-induced volume contraction, extracellular fluid volume was kept constant by a computer-driven servo-control technique. Two groups were pretreated with osmotic minipumps chronically infusing either FUR (0.25 mg/hr; group CF; n = 9) or vehicle (8% ethanolamine; group CV; n = 8) i.p. for 7 days before the experiment. During the experiment, two other groups received either acute infusion with FUR (0.25 mg/hr; group AF; n = 16) or acute infusion with vehicle (150 mM glucose; group AV; n = 11). After a 60-min control period, BFTZ (0.083 mg; 0.25 mg/hr) was administered for 90 min to all four groups. Whereas the diuretic and natriuretic response to BFTZ was similar in groups AF, AV and CV, a supra-additive response was observed in the CF group (vs. group CV: delta urine flow rate: +78%; delta urinary Na excretion: +69%). BFTZ had no effect on the fractional excretion of Li, which suggests that the supra-additive effect was due to inhibition of an enhanced distal tubular Na reabsorption induced by chronic FUR administration. Because before BFTZ administration urinary Na excretion was 3-fold higher during acute than during chronic FUR infusion, an increased delivery of NaCl to the thiazide segment cannot by itself explain the exaggerated BFTZ response during chronic FUR treatment.(ABSTRACT TRUNCATED AT 250 WORDS)