ASK DIS: Effectiveness of IVI Frusemide in CKD patients

Loop diuretics are the most commonly used diuretics in CKD.
In CKD Stages 4-5, furosemide should be started at a dose of 40 to 80 mg once daily with weekly titration upwards by 25% to 50% dependent upon the response and ECF volume.
Once an effective dose has been established, the frequency with which it needs to be administered can be determined by specific clinical needs.
In the absence of specific conditions causing increased sodium reabsorption (nephrotic syndrome, heart failure, or cirrhosis), a brisk diuretic response occurs in response to a loop diuretic with only nominal dose titration.
In patients with specific conditions causing increased sodium reabsorption, the response to a loop diuretic is attenuated in relationship to the severity of the underlying disease, and substantially higher doses of furosemide may be necessary to achieve a diuresis.
Furosemide is actively secreted by the proximal tubules into the urine before reaching its site of action at the ascending limb of loop of Henle.
It is the urinary concentrations of furosemide that determine its diuretic effect.
The severity of acute kidney injury has a significant effect on the diuretic response to furosemide; a good 'urinary response' may be considered as a 'proxy' for having some residual renal function.