Macula densa diuretics

Increased delivery of salt to the TAL leads to activation of the macula densa and a reduction in glomerular filtration rate (GFR) by tubuloglomerular (TG) feedback. The mechanism of this feedback is secretion of adenosine by macula densa cells, which locally causes afferent arteriolar vasoconstriction. This vasoconstriction reduces GFR. Tubuloglomerular feedback-mediated reduction in GFR exacerbates the reduction that was initially caused by decreased cardiac output. Recent work with adenosine receptor antagonists (eg, rolofylline) has shown that it will soon be possible to circumvent this complication of diuretic therapy in heart failure patients. Using rolofylline with a diuretic will make it possible to produce an effective diuresis in patients with heart failure without causing renal decompensation. 

Schlatter (1993) recorded membrane voltages of macula densa cells with the fast or slow whole-cell patch-clamp method. The effects of diuretics and the conductance properties of these cells were examined. 

Schlatter E (1993) Effect of various diuretics on membrane voltage of macula densa cells. Whole-cell patch-clamp experiments. Pfliigers Arch Eur J Physiol 423 74-77... 

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