The efficacy of diuretics in acute and chronic renal failure. Focus on torasemide.

Loop diuretics in high doses are the drugs of choice in the treatment of both acute renal failure (ARF) and chronic renal failure (CRF). Their pharmacokinetic and pharmacodynamic properties give them a high efficacy, even in severely compromised renal function. The serum elimination half-life and duration of action of most loop diuretics are dependent on the glomerular filtration rate and are therefore prolonged in renal failure. Torasemide, a new high ceiling and long acting loop diuretic, is as potent as furosemide (frusemide) in patients with advanced renal failure. Unlike other loop diuretics, the half-life and duration of action of torasemide are not dependent on renal function and the parent drug does not accumulate in renal failure. The extent of metabolism is clinically negligible. A number of studies have demonstrated the efficacy of furosemide, bumetanide, piretanide and torasemide in patients with ARF and CRF. When compared with the other loop diuretics, torasemide has the following advantages: a longer half-life independent of renal function, no indications of toxic side effects and apparently less influence on calciuresis.