Loop and thiazide diuretics
Where loop and thiazide diuretics act in the nephron, how tubular secretion and the dose-response curve explain dosing and resistance, and how the transport physiology explains hypokalaemia, alkalosis, hyponatraemia and the opposite effects on calcium.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Loop diuretics (furosemide, bumetanide) block NKCC2 in the thick ascending limb, which reabsorbs about 25% of filtered sodium. They are the most potent.
- Thiazides and thiazide-like drugs (hydrochlorothiazide, chlorthalidone, indapamide) block NCC in the distal convoluted tubule, which reabsorbs about 5 to 7%.
- Both act from the tubular lumen after secretion in the proximal tubule.
Loading the rest of the note…
Finished reading?
Sources
- Therapeutic Guidelines: CardiovascularAU/NZTherapeutic Guidelines Limited, 2026
- Australian Medicines HandbookAU/NZAustralian Medicines Handbook Pty Ltd, 2026
- Køber L, Adamo M et al. 2026 ESC Guidelines for the management of heart failure. Eur Heart J 2026. doi:10.1093/eurheartj/ehag100European Heart Journal (ESC), 2026
- LeGrand SB, Leskuski D, Zama I. Narrative review: furosemide for hypercalcemia: an unproven yet common practice. Ann Intern Med 2008;149:259-63Annals of Internal Medicine, 2008
- Felker GM, Lee KL, Bull DA et al. Diuretic strategies in patients with acute decompensated heart failure (DOSE). N Engl J Med 2011;364:797-805New England Journal of Medicine, 2011
- Trullàs JC, Morales-Rull JL, Casado J et al. Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial. Eur Heart J 2023;44:411-21European Heart Journal (ESC), 2023
- Ishani A, Cushman WC, Leatherman SM et al. Chlorthalidone vs hydrochlorothiazide for hypertension-cardiovascular events (Diuretic Comparison Project). N Engl J Med 2022;387:2401-10New England Journal of Medicine, 2022
- Agarwal R, Sinha AD, Cramer AE et al. Chlorthalidone for hypertension in advanced chronic kidney disease (CLICK). N Engl J Med 2021;385:2507-19New England Journal of Medicine, 2021
- Dhayat NA, Bonny O, Roth B et al. Hydrochlorothiazide and prevention of kidney-stone recurrence (NOSTONE). N Engl J Med 2023;388:781-91New England Journal of Medicine, 2023
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy