Triamterene and the Kidney

Sica, Domenic A.; Gehr, Todd W.B.

doi:10.1159/000185375

Cited by 33 publications

(8 citation statements)

References 32 publications

(107 reference statements)

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“…4 Urine sediment abnormalities occur in up to 54% of patients. 5, 6 Fairley et al 7 found triamterene crystals and casts in acidic urine in all 20 healthy individuals 2-11 hours after receiving a single 100-mg dose of triamterene.…”

Section: Discussionmentioning

confidence: 99%

Triamterene Crystalline Nephropathy

Nasr

Milliner

Wooldridge

et al. 2014

American Journal of Kidney Diseases

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Section: Discussionmentioning

confidence: 99%

Triamterene Crystalline Nephropathy

Nasr

Milliner

Wooldridge

et al. 2014

American Journal of Kidney Diseases

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“…Because of its weak BP-lowering properties, triamterene is seldom employed as monotherapy for hypertension. It is usually used in combination with a thiazide-type diuretic with the premise behind such a two-diuretic combination being that triamterene reduces the K + and Mg ++ losses that might otherwise accompany thiazide therapy [ 48 ]. Triamterene, given together with a NSAID, has been reported to cause acute kidney injury, which may last for several days.…”

Section: Triamterenementioning

confidence: 99%

Diuretics for the Treatment of Hypertension

Sica

2015

Pathophysiology and Pharmacotherapy of Cardiovascular Disease

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Diuretics are agents commonly used in diseases characterized by excess extracellular fl uid, including chronic kidney disease, nephrotic syndrome, cirrhosis, and heart failure. Diuretics are also commonly used either as monotherapy or in combination with other antihypertensive agents in the management of hypertension. Multiple diuretic classes, including thiazide-type diuretics, loop diuretics, and potassium-sparing diuretics, are used to treat patients with these diseases. An understanding of what determines a patient's response to a diuretic is a prerequisite to the correct use of these drugs. The response of patients with these diseases to diuretics, which is related to the dose, is best described by a sigmoid curve whose contour can become distorted by any of the several sodium-retaining states that are directly or indirectly associated with renal disease. The pharmacodynamic effect of diuretics as used in the treatment of hypertension involves both a volume removal element and more long-term vasodilation. Diuretic actions are of considerable importance to patients who have renal disease, as their effective use assists in extracellular fl uid volume control, reducing excretion of protein in urine and lessening the risk of developing hyperkalemia. Diuretic-related adverse events that involve the uric acid, sodium, and potassium axes are not uncommon; therefore, the clinician must be vigilant in looking for biochemical disturbances. As a result of diuretic-related adverse events, clinicians must be resourceful in the dose amount and frequency of dosing.

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“…Subsequent studies in the 1980s and early 1990s demonstrated that triamterene was a frequent nephrolithiasis culprit, accounting for up to onethird of drug-induced stone cases [3,7,[26][27][28]. Many patients had prior history of calcium or uric acid calculi, suggesting a mechanistic role of heterogeneous nucleation or accretion of triamterene onto prior stones [3,5,[26][27][28]. However, the last 15 years have seen a decline in the incidence of triamterene-related stones due to growing physician awareness and alternative hypertensive agents.…”

Section: Triamterenementioning

confidence: 99%

“…Daily doses of triamterene exceeding 150 mg are usually required for stone formation [3]. In addition, alkaline pH increases tubular reabsorption of triamterene, leading to a decrease in both crystalluria and calculi formation [28,33].…”

Section: Triamterenementioning

confidence: 99%

Miscellaneous Stone Types

Cutrell

Reilly

2011

Clinic Rev Bone Miner Metab

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Drug-induced calculi and other rare stone types, such as ammonium acid urate or protein matrix stones, represent only about 2% of all renal calculi. However, the chance to easily reverse stone formation risk by discontinuing the offending drug makes identification of these entities important for clinicians. Additionally, study of these rare stone types contributes to understanding the biochemistry of stone formation. Drug-induced calculi may be classified into two groups based on the mechanism of stone formation. The first group includes drugs that provoke calculi composed of principally the drug and its metabolites. These medications tend to be poorly soluble, highly excreted in urine, and required at high dosages for long durations of therapy. Historically, sulfonamides, triamterene, and the HIV protease inhibitor indinavir were leading causes of drug-induced calculi. Uses of novel agents within these drug classes or alternative therapies have reduced the incidence attributed to these drugs, although risk from newer, commonly used medications-notably ciprofloxacin, aminopenicillins, ceftriaxone, ephedrine, and guaifenesinare increasingly being recognized. Microscopic analysis for crystalluria or infrared spectroscopy of collected stones aid in recognition of calculi composed primarily of a drug and its metabolites. Understanding of drug metabolism and pharmacokinetics, particularly related to effects of urine pH on drug solubility and excretion, provides a rational basis for both prevention and treatment recommendations. When possible, clinicians should avoid or exercise great caution when prescribing these medications to patients with a prior history of stones. The second group of drug-induced calculi includes drugs that cause stones due to their metabolic effects, primarily on calcium or purine metabolism. Because these calculi are identical in physical composition to the more common nephrolithiasis types, careful medication history and high clinical suspicion are required for diagnosis of these drug-induced ''metabolic'' calculi. Most drugs in this class are readily expected based on their effects on urinary calcium excretion such as calcium/Vitamin D supplements and loop diuretics. Carbonic anhydrase inhibitors, including the antiepileptics topiramate and zonisamide, are also included in this group. Ammonium acid urate stones are endemic in developing countries due to dietary limitations and recurrent diarrheal illness, but rarely occur in developed countries. Identification of these stones should raise clinical suspicion of epidemiologic risk factors including recurrent urinary tract infections with urea-splitting organisms, inflammatory bowel disease, and laxative abuse. Interestingly, these unusual clinical scenarios can recapitulate a common biochemical pathway to stone formation. Protein matrix stones are another unusual stone type associated with specific epidemiologic factors, namely recurrent urinary infections and proteinuric end-stage renal disease. Although distinctly rare, protein matrix stones ...

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Triamterene and the Kidney

Cited by 33 publications

References 32 publications

Triamterene Crystalline Nephropathy

Triamterene Crystalline Nephropathy

Diuretics for the Treatment of Hypertension

Miscellaneous Stone Types

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