Nephron Remodeling as a Mechanism of Diuretic Resistance. When high doses of loop diuretics are used on a long-term basis, the distal nephron undergoes remodeling, with hypertrophy and hyperplasia of distal convoluted tubule cells, principal cells, and intercalated cells. This remodeling increases the reabsorptive capacity of the distal nephron by activating the thiazide-sensitive sodium chloride cotransporter, the epithelial sodium channel, and the chloride–bicarbonate exchanger pendrin. #Pathophysiology #Nephro #IM #LoopDiuretic #Resistance #NephronRemodeling #NEJM
