Talk:Aquaretic

I created this page because I am a pharmacist. I've always enjoyed phytopharmaceuticals and consider them a speciality of mine. I think this shows definite interest in the subject matter. I don't have any sources. I honestly don't know where to find any for this. Aquaretics is a little known term. I pulled this information from age old notes from pharmacy school. I also have taken classes on herbals and retained much of the information. I think expertise should count for something with this article, but if I need to not create articles via this outlet...someone let me know and I will try harder...:-)

[[TheAngriestPharmacist]] 06:22, 25 April 2007 (UTC)

I have a few issues with the article. First is with the meaning of diuretic. A diuretic is simply anything that increases urine, regardless of electrolyte content. (Dia- is from Greek for through, uretic refers to urine). Often times terms like natriuretic is used to indicate electrolyte content (natrium=sodium). (Also I don't believe -retic is a valid replacement for the -uretic suffix, but if aquaretic is to be an accepted term, I don't understand why this term would exclude synthetic drugs that achieve the same result.) Second, the statements made in the article are fairly bold...e.g. that GFR increase won't result in additional electrolytes being secreted. Or how these alleged herbal products are better than Evian or Budweiser at achieving the desired result of very dilute urine. Third, any statements about the usefulness of treatment should (unless obvious) cite some clinical trial, preferably of the double-blind sort...complete with P values, confidence intervals, and all that jazz. Also, the safety of these substances would need to be addressed with an external source. Mauvila 16:54, 23 October 2007 (UTC)

The term aquaretic itself is valid, but its use (at least in current medical/pharmacologic practice) refers to agents that cause pure water diuresis (as opposed to natriuresis, which is much more common.) The principal mechanism of action for this is inhibition of water uptake in the collecting tubules, generally by inhibiting the effects of vasopressin (ADH), which acts to increase water channels. [1] [2] Because all that this being added to urine is water (which ADH would normally cause to be reabsorbed via aquaporins), this is true aquaresis. The vaptans are the best-known aquaretic agents.

I have not seen any peer-reviewed source refer to the herbs listed here as aquaretics. In fact, of all the plants listed, I could only find a study discussing the mechanism of action of parsley [3]. It was reported to block the sodium-potassium ATPase on renal tubular cells, blocking potassium secretion and sodium reabsorption by changing the voltage and concentration gradients. This is natriuresis, not aquaresis, and it makes parsley a true diuretic, although most likely less potent (and correspondingly less dangerous) than loop diuretics and thiazides. There are no studies that I can find to support the vague mechanism listed ("increasing blood flow to the kidneys"), and this effect would, far from being safe and beneficial, actually be dangerous-- it is one of the major mechanisms for toxicity to the kidney from chronic NSAID abuse. --Kajerm (talk) 19:19, 14 December 2007 (UTC)

Sounds not only like natriuresis, but like spironolactone a little. But as far as what the article is theoretically referring to, they may not be natriuretics, but they still are diuretics. As the article is now, it says they aren't diuretics, and then it goes on to say they increase urine output. This is contradictory. And it seems like aquaretics would cause hypernatremia...where does all the salt go, anyway? Also, I still don't see what about the term aquaretic signifies "natural", whatever natural means... Mauvila (talk) 08:10, 15 December 2007 (UTC)

A true aquaretic should cause hypernatremia, in order to oppose the hyponatremic effect of vasopressin. Their clinical indication is for SIADH. By acting directly on aquaporins, aquaretics cause a pure-water diuresis. The salt is reabsorbed to the same extent as it normally is, a increasing serum sodium. Remember that the sole action of ADH in the kidney is to increase water reabsorption in the collecting tubules by upregulating AQP2; unlike aldosterone, this mechanism of antidiuresis is sodium-independent and dilutes the blood. That is its physiologic function. There is no evidence of any kind to suggest that the herbals referred to in the article are aquaretics in the current sense of the word-- they do not cause pure-water diuresis. --Kajerm (talk) 04:24, 8 February 2008 (UTC)

Proposal for deletion

I've tagged this article for deletion for a number of reasons:

• Most importantly, aquaretic is almost never used as a noun. It's usage is much more similiar to that of natriuretic (an adjective) than diuretic. As a result I believe it merits a wiktionary definition, but not a wikipedia article.
• As you guys have already pointed out, the current article content is both unverified and apparently inaccurate. I don't claim to be an expert, but the increased renal perfusion -> increased GFR -> increased H2O loss argument seems very unlikely without some kind of interference with ADH or some additional diuretic effect in the distal tubule/collecting duct.
• With the greatest respect to its original author, I do not believe there is any content currently in the article worth preserving. If you disagree, however, perhaps it would be better merged into the diuresis article? Or used in the creation of a new aquaresis article?

I believe this meets some of the criteria for deletion. Thebagman (talk) 22:55, 21 December 2007 (UTC)

Aquaretics - a type of diuretic

A diuretic is by definition something that increases urine output. So to decide whether "aquaretics" is a diuretic, you need to ask, "Does this have an effect on urine output?" and if you say yes, you need to ask, "Does it increase or decrease urine output?" If you say "increase", then you have a diuretic. There is nothing built-into the word "diuretic" that has anything to do with osmolarity of the urine output. It's quite an old word, and it's quite generic. Mauvila (talk) 07:57, 9 February 2008 (UTC)

I don't know what this was in response to, but yes, an aquaretic is a type of diuretic that causes a pure-water diuresis. --Kajerm (talk) 07:58, 11 February 2008 (UTC)

The article contrasts aquaretics with diuretics...which makes no sense. Perhaps it could be contrasted with "typical diuretics", but not simply diuretics. Mauvila (talk) 04:58, 12 February 2008 (UTC)

The article as it exists is in horrible shape; the herbal "aquaretics" referred to are [b]not[/b] aquaretics, they are by and large natriuretic agents with conventional actions, insofar as any evidence exists for them being diuretics at all. I made this point before on this talk page, with medline searches and journal articles to boot.

This article really needs to be reworked from the ground up. I would be bold and do it myself, but unfortunately I just can't scrape together the time at the moment. I notice that you've contributed significantly to a lot of high-quality medicine-related articles; if you're amenable, I'd be more than happy to collaborate with you on completely rewriting this one. --Kajerm (talk) 18:53, 12 February 2008 (UTC)

Increase blood pressure?

This doesn't make sense. I don't have access to the cited source, so I can't check it. Given the title (Herbal Medicinals: A Clinician's Guide), they were probably referring to herbals, but even this seems strange. --ἀνυπόδητος (talk) 17:32, 9 March 2014 (UTC)

For me it doesn't make sense either, and the only aquaretic approved for patient use (ie. tolvaptan) does not cause any increase in blood pressure as far as the scientific literature is concerned. Someone should change that sentence in the article. The Pathologist (talk) 00:51, 26 May 2015 (UTC)