Diuretics in pediatrics

Eur J Pediatr. 2023 May;182(5):2077-2088. doi: 10.1007/s00431-022-04768-2. Epub 2023 Jan 3.


Diuretics are frequently prescribed drugs and help managing several pathological conditions, including acute and chronic kidney disease, nephrotic syndrome, congestive heart failure, ascites, systemic and pulmonary hypertension. Diuretic classes include among others osmotic diuretics and carboanhydrase inhibitors, loop diuretics, thiazides, and potassium-sparing diuretics. In this educational article, we aim at reviewing indications, mechanisms of action, and side effects, as well as basic pharmacokinetics considerations and data on diuretics in children, supporting practicing clinicians in choosing (and understanding the background of) the best-suited diuretic regimen for the individual patient. Newer diuretic classes like vaptans and sodium glucose type 2 cotransporter inhibitors, the recent controversies on hydrochlorothiazide, and the issue of diuretic resistance, will also be briefly addressed.

Conclusion: This educational review offers a didactical overview of diuretics in Pediatrics.

What is known: • Diuretics are frequently prescribed drugs in both adults and children. • They increase water and sodium excretion, reducing fluid overload.

What is new: • This article reviews indications, mechanisms of action, side effects, and basic pharmacokinetics facts on diuretics in Paediatrics. • It also addresses current issues, like the management of diuretic resistance, the recent controversy on hydrochlorothiazide, and the novel classes vaptans and gliflozins.

Keywords: Child; Diuretic; Fluid overload; Furosemide; Hydrochlorothiazide; Spironolactone.

Publication types

  • Review

MeSH terms

  • Adult
  • Child
  • Diuretics* / pharmacology
  • Diuretics* / therapeutic use
  • Heart Failure* / chemically induced
  • Heart Failure* / drug therapy
  • Humans
  • Hydrochlorothiazide / therapeutic use
  • Sodium
  • Sodium Potassium Chloride Symporter Inhibitors / adverse effects


  • Diuretics
  • Hydrochlorothiazide
  • Sodium Potassium Chloride Symporter Inhibitors
  • Sodium