Quote from iluvnoodles
I thought diuretics are contraindicated in kidney insufficiency. In school, the teachers said, if your patients aren't peeing, than don't give them diuretics. In my research it kept on showing that it's used to treat kidney disease. So I guess I'm a bit confused...
One important thing to remember about school: they are covering generalizations...when you get into practice, you may find out your school lectures weren't always right on for the specific population you are seeing.
You aren't using diuretics to treat the kidney
disease, you're using it to compensate for the renal insufficiency. Case in point, dealing with heart failure and renal insufficiency, the kidney's can't cause enough diuresis on their own, you give them diuretics to treat the heart failure. You need to get that fluid off in an acute flare-up and need to keep it off in chronic management. So you increase the renal sufficiency by adding the diuretic.
You need to look at the overall process you're dealing with. You're not going to just deal with one system here, you're dealing with the whole body. So you're going to monitor kidney function (in the example cited) to deal with the heart failure. The kidney's are only going to let you diurese to a point....then you run the risk of kidney failure. This is definitely an area where clinician skill comes into play. You know your patients, you know how far you can push things. Make sense?