Expansion of extracellular fluid volume is central to the pathophysiology of heart failure. Increased extracellular fluid leads to elevated intracardiac filling pressures, resulting in a constellation of signs and symptoms of heart failure referred to as congestion. Loop diuretics are one of the cornerstones of treatments for heart failure, but in contrast to other therapies, robust clinical trial evidence to guide the use of diuretics is sparse. A nuanced understanding of renal physiology and diuretic pharmacokinetics is essential for skillful use of diuretics in the management of heart failure in both the inpatient and outpatient settings. Diuretic resistance, defined as an inadequate quantity of natriuresis despite an adequate diuretic regimen, is a major clinical challenge that generally portends a poor prognosis. In this review, the authors discuss the fundamental mechanisms and physiological principles that underlie the use of diuretic therapy and the available data on the optimal use of diuretics.

中文翻译：

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心力衰竭患者的利尿疗法

细胞外液体积的膨胀是心力衰竭病理生理学的核心。细胞外液增加导致心内充盈压升高，导致心力衰竭的一系列体征和症状，称为充血。Loop 利尿剂是治疗心力衰竭的基石之一，但与其他疗法相比，指导利尿剂使用的可靠临床试验证据很少。对肾脏生理学和利尿剂药代动力学的细致了解对于在住院和门诊环境中熟练使用利尿剂治疗心力衰竭至关重要。利尿剂抵抗被定义为尽管有足够的利尿剂方案但尿钠排泄量不足，这是一个主要的临床挑战，通常预示着预后不良。在这次审查中，