CLINICAL NEPHROLOGY: Edited by Bradley M. DenkerAre diuretics harmful in the management of acute kidney injury?Ejaz, A. Ahsan; Mohandas, RajeshAuthor Information Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, Florida, USA Correspondence to A. Ahsan Ejaz, MD, Division of Nephrology, Hypertension and Transplantation, University of Florida, P.O. Box 100224, Gainesville, FL 32610, USA. Tel: +1 352 273 5328; fax: +1 352 392 3581; e-mail: [email protected] Current Opinion in Nephrology and Hypertension: March 2014 - Volume 23 - Issue 2 - p 155-160 doi: 10.1097/01.mnh.0000441150.17202.be Buy Metrics Abstract Purpose of review To assess the role of diuretics in acute kidney injury (AKI) and their effectiveness in preventing AKI, achieving fluid balance, and decreasing progression to chronic kidney disease (CKD). Recent findings Diuretics are associated with increased risk for AKI. The theoretical advantage of diuretic-induced preservation of renal medullary oxygenation to prevent AKI has not been proven. A higher cumulative diuretic dose during the dialysis period can cause hypotension and increase mortality in a dose-dependent manner. Data on the use of forced euvolemic diuresis to prevent AKI remains controversial. Positive fluid balance has emerged as an independent predictor of adverse outcomes. Post-AKI furosemide dose had a favorable effect on mortality due in part to the reduction of positive fluid balance. There are exciting experimental data suggesting that spironolactone may prevent AKI once an ischemic insult has occurred and thus prevent the progression to CKD. Summary Diuretics are ineffective and even detrimental in the prevention and treatment of AKI, and neither shorten the duration of AKI, nor reduce the need for renal replacement therapy. Diuretics have an important role in volume management in AKI, but they are not recommended for the prevention of AKI. There is increased emphasis on the prevention of progression of AKI to CKD. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.