[Etiology and treatment of diuretic resistance]

Basically the cause of the resistance to diuretics can be found out. Essential is a detailed knowledge of the physiology and pathophysiology of volume regulation as well as renal water and electrolyte excretion. To get diagnostic and therapeutic access to diuretic resistance main efforts have to be put into the work up of current diagnostics and therapy of the main disease (heart failure, liver failure, nephrotic syndrome, and renal failure) as well as the symptomatic, drug related volume regulation (exact balancing of fluid intake and excretion with and without diuretics) in these severely ill patients. Has the underlying cause for resistance to diuretic medication been found, therapy is generally easy and effective. It might be unsuccessful in patients with severe impairment of renal function. Then the only way may be extracorporeal fluid removal.