FUROSEMIDE

• Furosemide is a loop diuretic that acts on the kidneys to ultimately

increase water loss from the body. Loop diuretics selectively inhibit
NaCl reabsorption in the thick ascending limb of the loop of Henle.
• Furosemide is indicated in adults and pediatric patients for the
treatment of edema associated with congestive heart failure, cirrhosis
of the liver, and renal disease, including the nephrotic syndrome.
It is also indicated for the treatment of hypertension alone or in
combination with other antihypertensive agents in adults who were
not shown to be inadequately controlled with thiazides.
• Pharmacokinetic:
1. Absorption: 2-3 hours
2. DOA : 2-3 hours
3. Eliminated by tubular
secretion and glomerular
filtration
4. Half-life depend on renal
function
Dosage:20-80 mg
• Pharmacodynamic
Furosemide promotes diuresis by
blocking tubular reabsorption of
sodium and chloride in the
proximal and distal tubules, as
well as in the thick ascending loop
of Henle. This is achieved through
competitive inhibition of sodium-
potassium-chloride cotransporters
 NUTRITIONAL
RECOMMENDATION

(calorie, protein, water, sodium, and potassium)

 PROTEIN

• Suggest lowering protein intake to 0.8 g/kg/day in adults with diabetes or

without diabetes and GFR <30 ml/min/ 1.73 m2
• DPI for clinically stable MHD patients is 1.2 g/kgBW/d
• DPI for CPD is 1.2 to 1.3 g/kgBW/d
• At least 50% of the dietary protein should be of high biological value (has
amino acid composition that is similar to human protein
 SODIUM AND POTTASIUM

• Lowering salt intake to <90 mmol ( <2 g) per day of sodium (corresponding to
5g of NACL)in adults, unless contraindicated
• Dietary potassium restriction is often recommended in patient in hyperkalemia
(<3 g/day {77mmol/day}). In healthy adults, including those at high risk for
kidney disease the daily potassium intake is 4.7 g (120mmol)
 CARBOHYDRATE

• Unrefined carbohydrate account for half the usual daily energy intake, the
proportion may be even higher wit a low-protein diet
• In patient, with kidney disease, carbohydrates should be complexed awith hogh
fiver content (whole-wheat breads, multigrain cereal, oatmeal, and mixed fruit
and vegetables) to help reduce dietery phosphorous and protein such as urea
and creatinine regeneration
• The recommended daily energy intake for MHD or chronic peritoneal dialysis
ppatients is 35 kcal/kg body weight/d for those who are less than 60 years, and
30-35 kcal/kg body weight/d for individuals 60 years or older
 FATS

• Non saturated fat is the preferred lipid in the diet. Replacement of butter with
flaxseed, canola, or olive oil, all of which are rich in n-3 fatty acids.
• In low protein diet, fat and carbohydrate should together account for more than
90% of the daily energy intake requirement if 30-35 kcal / kg to avoid protein
wasting.
 WATER

• CKD pre-dialysis: not restricted with a normal urine

• CKD-HD: 500 ml/d + urine production
• CKD-PD: 1500-2000 mL/d, do daily control
• Renal Transplantation: acute phase: euvolemic/ slightly hypervolemic with
insensible water loss about 30-60 mL/h
 SOURCE

• Katzung Basic Clinical Pharmacology

• www.drugbank.com
• KDIGO 2012
• KDOQI 2000
• Nutritional Management of Chronic Kidney Disease,NEJM
• Kapita Selekta, pg 644