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In reply

We thank Fukuda and Kimura for their comments on our article. While we concur with them that a reduction in glomerular pressure may be renoprotective, we do not a priori accept the statement that diuretics work that way. In this regard, several arguments need to be considered.

First, many other mechanisms, including, for instance, stimulation of the renin-angiotensin-aldosterone system, are involved in attaining a new steady state of sodium balance, when sodium intake is reduced by dietary manipulation or when sodium output is enhanced by a diuretic. The adaptation to diuretic treatment occurs swiftly and may precede any fall in blood pressure. In other words, it is not absolutely necessary to lower GFR to achieve a new steady state of sodium balance.

Second, the statement that diuretics do not affect serum sodium is too optimistic. In fact, the use of thiazides is often associated with some fall in . . . [Full Text of this Article]

AUTHOR INFORMATION
Peter W. de Leeuw, MD, PhD; Luis M. Ruilope, MD, PhD for the INSIGHT Investigators

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