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Current Hypertension Reviews


ISSN (Print): 1573-4021
ISSN (Online): 1875-6506

Mini-Review Article

Role of Plant Bioactive as Diuretics: General Considerations and Mechanism of Diuresis

Author(s): Manvi, Mohammad Irfan Khan*, Badruddeen, Juber Akhtar, Mohammad Ahmad, Zeba Siddiqui and Gayyur Fatima

Volume 19, Issue 2, 2023

Published on: 19 July, 2023

Page: [79 - 92] Pages: 14

DOI: 10.2174/1573402119666230612115220

Price: $65


Background: Medicinal plants have been found beneficial in the control and therapy of many ailments as they contain bioactive compounds, and many of them are used as precursors in the biosynthesis of natural medicines. Diuretics are used as a primary treatment in patients with edema associated with liver cirrhosis and kidney diseases, hyperkalemia, hypertension, heart failure, or renal failure. Furthermore, they are also used to increase the excretion of sodium and reduce blood volume. Due to various adverse events associated with synthetic diuretics, there is a need to investigate alternate plant-based bioactive components that have effective diuretic activity with minimal side effects.

Objective: This review compiled the reported bioactive compounds from different plant sources along with their mechanisms of diuretic activity.

Methods: Different sources were used to collect information regarding herbal plants with therapeutic value as diuretics. These included published peer-reviewed journal articles, scholarly articles from StatPearls, and search engines like Google Scholar, PubMed, Scopus, Springer, ScienceDirect, Wiley, etc.

Results: In this review, it was found that flavonoids like rutin, acacetin, naringenin, etc. showed significant diuretic activity in experimental models by various mechanisms, but mostly by blocking the sodium-potassium-chloride co-transporter, while some bioactive compounds showed diuretic actions via other mechanisms as well.

Conclusion: Research on clinical trials of these isolated bioactive compounds needs to be further conducted. Thus, this review provides an understanding of the potential diuretic bioactive compounds of plants for further research and pharmaceutical applications.

Keywords: Diuretic, bioactive compounds, flavonoids, alkaloids, saluretic, natriuretic, hypertension.

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Graphical Abstract
Arumugham VB, Shahin MH. Therapeutic Uses of Diuretic Agents. In: StatPearls
Fuchs FD. Diuretics: drugs of choice for the initial management of patients with hypertension. Expert Rev Cardiovasc Ther 2020 1(1): 35-41.2023.
[] [PMID: 15030295]
Qavi AH, Kamal R, Schrier RW. Clinical use of diuretics in heart failure, cirrhosis, and nephrotic syndrome. Int J Nephrol 2015; 2015: 1-9.
[] [PMID: 26294976]
Kaufman DP, Basit H, Knohl SJ. Physiology, glomerular filtration rate. In: StatPearls. 2023.
Van Berkel MA, Elefritz JL. Evaluating off-label uses of acetazolamide. Am J Health Syst Pharm 2018; 75(8): 524-31.
[] [PMID: 29626002]
Sands JM, Layton HE. The urine concentrating mechanism and urea transporters. 2013.
Mount DB. Thick ascending limb of the loop of Henle. Clin J Am Soc Nephrol 2014; 9(11): 1974-86.
[] [PMID: 25318757]
Ellison DH. Clinical pharmacology in diuretic use. Clin J Am Soc Nephrol 2019; 14(8): 1248-57.
[] [PMID: 30936153]
Kleyman TR, Cragoe EJ Jr. The mechanism of action of amiloride. Semin Nephrol 1988; 8(3): 242-8.
Shah SU, Anjum S, Littler WA. Use of diuretics in cardiovascular diseases: (1) heart failure. Postgrad Med J 2004; 80(942): 201-5.
[] [PMID: 15082840]
Dutta KN, Chetia P, Lahkar S, Das S. Herbal plants used as diuretics: A comprehensive review. J Pharm Chem Biol Sci 2014; 2(1): 27-32.
Ramkumar GG, Parthiban P, Kanakavalli K, Prabakaran R, Vanan ST. Diuretic herbs on siddha system of medicine-a review. International Journal of Research in Pharmaceutical and Nano Sciences 2014; 3(1): 43-9.
Zinkovsky D. Side effects, ADRs & ADEs of diuretics. In: Side Effects of Drugs Annual. 2021; 43: pp. 259-65.
Hailu W, Engidawork E. Evaluation of the diuretic activity of the aqueous and 80% methanol extracts of Ajuga remota Benth (Lamiaceae) leaves in mice. BMC Complement Altern Med 2014; 14(1): 135.
[] [PMID: 24720845]
Chakraborty M, Kamath JV, Bhattacharjee A. Potential interaction of green tea extract with hydrochlorothiazide on diuretic activity in rats. International Scholarly Research Notices 2014; 2014: 273908.
Hussein RA, El-Anssary AA. Plants secondary metabolites: The key drivers of the pharmacological actions of medicinal plants. Herb Med 2019; 1(3)
Sayana SB, Christina C, Medabala T, Patil PS. Study of diuretic activity of ethonolic extract of leaves of Cissampelos pareira in rats. Asian J Pharm Clin Res 2014; 7: 157-9.
Burak M, Imen Y. Flavonoids and their antioxidant properties. Turk Klin Tip Bilim Derg 1999; 19: 296-304.
Panche AN, Diwan AD, Chandra SR. Flavonoids: An overview. J Nutr Sci 2016; 5: e47.
[] [PMID: 28620474]
Lee YK, Yuk DY, Lee JW. et al. (−)-Epigallocatechin-3-gallate prevents lipopolysaccharide-induced elevation of beta-amyloid generation and memory deficiency. Brain Res 2009; 1250: 164-74.
[] [PMID: 18992719]
Castañeda-Ovando A, Pacheco-Hernández ML, Páez-Hernández ME, Rodríguez JA, Galán-Vidal CA. Chemical studies of anthocyanins: A review. Food Chem 2009; 113(4): 859-71.
Hunyadi A. The mechanism(s) of action of antioxidants: From scavenging reactive oxygen/nitrogen species to redox signaling and the generation of bioactive secondary metabolites. Med Res Rev 2019; 39(6): 2505-33.
[] [PMID: 31074028]
Bonfield K, Amato E, Bankemper T. et al. Development of a new class of aromatase inhibitors: Design, synthesis and inhibitory activity of 3-phenylchroman-4-one (isoflavanone) derivatives. Bioorg Med Chem 2012; 20(8): 2603-13.
[] [PMID: 22444875]
Choy KW, Murugan D, Leong XF, Abas R, Alias A, Mustafa MR. Flavonoids as natural anti-inflammatory agents targeting nuclear factor-kappa B (NFκB) signaling in cardiovascular diseases: A mini review. Front Pharmacol 2019; 10: 1295.
[] [PMID: 31749703]
Khan AU, Dagur HS, Khan M, Malik N, Alam M, Mushtaque M. Therapeutic role of flavonoids and flavones in cancer prevention: Current trends and future perspectives. Eur J Med Chem Reports 2021; 3: 100010.
Ansari MN, Ganaie MA, Khan TH, Samad A, Madkhali HA, Ahamad SR. Evaluation of the diuretic potentials of naringenin in hypercholesterolemic rats. Trop J Pharm Res 2018; 17(2): 239-44.
Alarc de la Lastra CÓ, Martín MJ, Motilva V. Effects of naringenin and silymarin on urinary excretion of water and electrolytes in rats. Phytother Res 1991; 5(4): 191-3.
Kalinina SA, Elkina OV, Kalinin DV, Syropyatov BY, Dolzhenko AV. Diuretic activity and toxicity of some Verbascum nigrum extracts and fractions. Pharm Biol 2014; 52(2): 191-8.
[] [PMID: 24074166]
Galati EM, Trovato A, Kirjavainen S, Forestieri AM, Rossitto A, Monforte MT. Biological effects of hesperidin, a Citrus flavonoid.(Note III): Antihypertensive and diuretic activity in rat. Farmaco (Societa chimica italiana: 1989) 1996; 51(3): 219.
Anwer MK, Al-Mansoor MA, Jamil S, Al-Shdefat R, Ansari MN, Shakeel F. Development and evaluation of PLGA polymer based nanoparticles of quercetin. Int J Biol Macromol 2016; 92: 213-9.
[] [PMID: 27381585]
Gasparotto A Junior, Prando TBL, Leme TSV. et al. Mechanisms underlying the diuretic effects of Tropaeolum majus L. extracts and its main component isoquercitrin. J Ethnopharmacol 2012; 141(1): 501-9.
[] [PMID: 22465728]
Boeing T, da Silva LM, Mariott M, Andrade SF, de Souza P. Diuretic and natriuretic effect of luteolin in normotensive and hypertensive rats: Role of muscarinic acetylcholine receptors. Pharmacol Rep 2017; 69(6): 1121-4.
[] [PMID: 29128789]
Stephen I, Revathi G, Pradeepha P, Arthy M, Swathi PR, Mounnissamy VM. Diuretic activity of rutin isolated from Cansjera rheedii J. Gmelin (opiliaceae). World J Pharmaceut Med Res 2018; 4(5): 260-2.
de Souza P, da Silva LM, Boeing T. et al. Influence of prostanoids in the diuretic and natriuretic effects of extracts and kaempferitrin from Bauhinia forficata Link leaves in rats. Phytother Res 2017; 31(10): 1521-8.
[] [PMID: 28752576]
Cechinel-Zanchett CC, Bolda Mariano LN, Boeing T. et al. Diuretic and renal protective effect of kaempferol 3-O-alpha-l-rhamnoside (afzelin) in normotensive and hypertensive rats. J Nat Prod 2020; 83(6): 1980-9.
[] [PMID: 32453565]
Fazle R, Amir Z, Amna N, Muhammad S, Saifullah Khan K, Abid Ali A. In vivo laxative, anti-diarrheal, hepatoprotective and diuretic investigations of Sterculia diversifolia and its isolated compound. J Tradit Chin Med 2021; 41(5): 717-24.
[PMID: 34708629]
Nayak BS, Ellaiah P, Dinda SC, Moharana BP, Khadanga M, Nayak S. Diuretic activity of flavonoid compound isolated from Gmelina arborea fruits extract. Eur J Pharm Med Res 2017; 4(2): 616-22.
Kurek J, Ed. Alkaloids: Their importance in Nature and Human life. BoD–Books on Demand 2019.
Konrath EL, Passos CS, Klein-Júnior LC, Henriques AT. Alkaloids as a source of potential anticholinesterase inhibitors for the treatment of Alzheimer’s disease. J Pharm Pharmacol 2013; 65(12): 1701-25.
[] [PMID: 24236981]
Bali ZK, Bruszt N, Kőszegi Z. et al. Aconitum Alkaloid songorine exerts potent gamma-aminobutyric Acid-A receptor agonist action in vivo and effectively decreases anxiety without adverse sedative or psychomotor effects in the rat. Pharmaceutics 2022; 14(10): 2067.
[] [PMID: 36297502]
Mansoor A, Asrar M. Evaluation of diuretic activity of extracts of Gentiana oliveri and gentianine in rats. J Pharm Pharm Sci 2015; 4: 39-42.
Massey LK, Berg TA. The effect of dietary caffeine on urinary excretion of calcium, magnesium, phosphorus, sodium, potassium, chloride and zinc in healthy males. Nutr Res 1985; 5(11): 1281-4.
Zhang Y, Coca A, Casa DJ, Antonio J, Green JM, Bishop PA. Caffeine and diuresis during rest and exercise: A meta-analysis. J Sci Med Sport 2015; 18(5): 569-74.
[] [PMID: 25154702]
Ming Z, Lautt WW. Caffeine-induced natriuresis and diuresis via blockade of hepatic adenosine-mediated sensory nerves and a hepatorenal reflex. Can J Physiol Pharmacol 2010; 88(11): 1115-21.
[] [PMID: 21076499]
Rodrigues J, Hullatti KK, Unger BS. Saluretic effect of alkaloidal fraction from Cyclea peltata root in rats. J Glob Trends Pharm Sci 2020; 11(2): 7925-32.
Somova LI, Shode FO, Moodley K, Govender Y. Cardiovascular and diuretic activity of kaurene derivatives of Xylopia aethiopica and Alepidea amatymbica. J Ethnopharmacol 2001; 77(2-3): 165-74.
[] [PMID: 11535360]
Yarnell E. Plant chemistry in veterinary medicine: Medicinal constituents and their mechanisms of action. Veterinary Herbal Med 2007; pp. 159-82.
Wring SA, Randolph R, Park S. et al. Preclinical pharmacokinetics and pharmacodynamic target of SCY-078, a first-in-class orally active antifungal glucan synthesis inhibitor, in murine models of disseminated candidiasis. Antimicrob Agents Chemother 2017; 61(4): e02068-16.
[] [PMID: 28137806]
Safe S, Prather P, Brents L, Chadalapaka G, Jutooru I. Unifying mechanisms of action of the anticancer activities of triterpenoids and synthetic analogs. Anti Cancer Agents Med Chem 2012; 12(10): 1211-20.
Putta S, Sastry Yarla N, Kumar Kilari E. et al. Therapeutic potentials of triterpenes in diabetes and its associated complications. Curr Top Med Chem 2016; 16(23): 2532-42.
[] [PMID: 27086788]
Zhang X, Li XY, Lin N. et al. Diuretic activity of compatible triterpene components of Alismatis rhizoma. Molecules 2017; 22(9): 1459.
[] [PMID: 28878160]
Rizvi SH, Shoeb A, Kapil RS, Popli SP. Two diuretic triterpenoids from Antidesma menasu. Phytochemistry 1980; 19(11): 2409-10.
de Souza P, Boeing T, Somensi LB. et al. Diuretic effect of extracts, fractions and two compounds 2α3β19α-trihydroxy-urs-12-en-28-oic acid and 5-hydroxy-3,6,7,8,4′-pentamethoxyflavone from Rubus rosaefolius Sm. (Rosaceae) leaves in rats. Naunyn Schmiedebergs Arch Pharmacol 2017; 390(4): 351-60.
[] [PMID: 28013356]
Li Y, Tan Y, Wei N, Zhang J. Diuretic and anti-diuretic bioactivity differences of the seed and shell extracts of Alpinia oxyphylla fruit. Afr J Tradit Complement Altern Med 2016; 13(5): 25-32.
[] [PMID: 28487890]
Schlickmann F, Boeing T, Mariano LNB. et al. Gallic acid, a phenolic compound isolated from Mimosa bimucronata (DC.) Kuntze leaves, induces diuresis and saluresis in rats. Naunyn Schmiedebergs Arch Pharmacol 2018; 391(6): 649-55.
[] [PMID: 29663016]
Păltinean R, Mocan A, Vlase L. et al. Evaluation of polyphenolic content, antioxidant and diuretic activities of six Fumaria species. Molecules 2017; 22(4): 639.
[] [PMID: 28420145]
Angappan R, Devanesan AA, Thilagar S. Diuretic effect of chlorogenic acid from traditional medicinal plant Merremia emarginata (Burm. F.) and its by product hippuric acid. Clinical Phytoscience 2018; 4(1): 29.
Moser JC, Cechinel-Zanchett CC, Mariano LNB, Boeing T, da Silva LM, de Souza P. Diuretic, natriuretic and Ca2+-sparing effects induced by rosmarinic and caffeic acids in rats. Rev Bras Farmacogn 2020; 30(4): 588-92.
Bolda Mariano LN, Boeing T, da Silva RCMVAF. et al. 1,3,5,6-Tetrahydroxyxanthone, a natural xanthone, induces diuresis and saluresis in normotensive and hypertensive rats. Chem Biol Interact 2019; 311: 108778.
[] [PMID: 31377058]
Bolda Mariano LN, Boeing T, Cechinel-Filho V, Niero R, Mota da Silva L, de Souza P. The acute diuretic effects with low-doses of natural prenylated xanthones in rats. Eur J Pharmacol 2020; 884: 173432.
[] [PMID: 32745607]
Bolda Mariano LN, Boeing T, Cechinel Filho V. et al. Prolonged diuretic and renoprotective effects of a xanthone obtained from Garcinia achachairu rusby in normotensive and hypertensive rats. Evid Based Complement Alternat Med 2021; 2021: 1-9.
[] [PMID: 33995544]
de Almeida CLB, Cechinel-Filho V, Boeing T. et al. Prolonged diuretic and saluretic effect of nothofagin isolated from Leandra dasytricha (A. Gray) Cogn. leaves in normotensive and hypertensive rats: Role of antioxidant system and renal protection. Chem Biol Interact 2018; 279: 227-33.
[] [PMID: 29198636]
Fu G, Pang H, Wong Y. Naturally occurring phenylethanoid glycosides: Potential leads for new therapeutics. Curr Med Chem 2008; 15(25): 2592-613.
[] [PMID: 18855681]
Vogt T. Phenylpropanoid biosynthesis. Mol Plant 2010; 3(1): 2-20.
[] [PMID: 20035037]
Li C, Wen R, Liu DW. et al. Diuretic effect and metabolomics analysis of crude and salt-processed Plantaginis semen. Front Pharmacol 2020; 11: 563157.
[] [PMID: 33390941]
He J, Zeng L, Wei R. et al. Lagopsis supina exerts its diuretic effect via inhibition of aquaporin-1, 2 and 3 expression in a rat model of traumatic blood stasis. J Ethnopharmacol 2019; 231: 446-52.
[] [PMID: 30394291]
Zhao Y, Xie R, Chao X, Zhang Y, Lin R, Sun W. Bioactivity-directed isolation, identification of diuretic compounds from Polyporus umbellatus. J Ethnopharmacol 2009; 126(1): 184-7.
[] [PMID: 19665537]
Babotă M, Voştinaru O, Păltinean R, et al. Chemical composition, diuretic, and antityrosinase activity of traditionally used Romanian Cerasorum stipites. Front Pharmacol 2021; 12: 647947.
[] [PMID: 34045959]
Dadi DW, Emire SA, Hagos AD. et al. Antihyperglycemic, vasodilator, and diuretic activities of microencapsulated bioactive product from Moringa stenopetala leaves extract. J Food Qual 2020; 2020: 1-8.
Meharie BG, Tunta TA. Evaluation of diuretic activity and phytochemical contents of aqueous extract of the shoot apex of Podocarpus falcactus. J Exp Pharmacol 2020; 12: 629-41.
[] [PMID: 33364857]
Amat AG, De Battista GA, Uliana RF. Diuretic activity of Eugenia uniflora L. (Myrtaceae) aqueous extract. Acta Hortic 1999; (501): 155-8.
Sowmya S, Perumal PC, Gopalakrishnan VK. Chromatographic and spectrophotometric analysis of bioactive compounds from cayratia trifolia (L.) stem. Int J Pharm Pharm Sci 2016; 8: 56-64.
Bouaziz A, Khennouf S, Abu Zarga M, Abdalla S. In vitro anti-oxidant, hypotensive and diuretic activities of Origanum glandulosum in rat. Bangladesh J Pharmacol 2019; 14(1): 17-25.
Sirisha N, Sreenivasulu M, Sangeeta K, Latha GS, Devi AL, Chetty CM. A review on herbal diuretics. Res J Pharm Technol 2011; 4(3): 335-48.
Ratnasooriya WD, Amarakoon AMT, Abeywickrama KRW. Oral diuretic activity of hot water infusion of Sri Lankan black tea (Camellia sinensis L.) in rats. Pharmacogn Mag 2010; 6(24): 271-7.
[] [PMID: 21120027]
Ismail CA, Baraka AM, Abdallah RM, El-Dien OG, Mostafa DK. Spergularia marina: A potential source of a novel calcium channel blocker with antihypertensive and diuretic activities. Eur Rev Med Pharmacol Sci 2022; 26(2): 506-17.
[PMID: 35113427]
Bell M, Jackson E, Mi Z, McCombs J, Carcillo J. Low-dose theophylline increases urine output in diuretic-dependent critically ill children. Intensive Care Med 1998; 24(10): 1099-105.
[] [PMID: 9840247]
Clare BA, Conroy RS, Spelman K. The diuretic effect in human subjects of an extract of Taraxacum officinale folium over a single day. J Altern Complement Med 2009; 15(8): 929-34.
[] [PMID: 19678785]
Kumar MC, Udupa AL, Sammodavardhana K, Rathnakar UP, Shvetha U, Kodancha GP. Acute toxicity and diuretic studies of the roots of Asparagus racemosus Willd in rats. West Indian Med J 2010; 59(1): 03-6.
Pereira CRP, da Silva YS, Cechinel-Zanchett CC. et al. A rare 6-O-glucoside flavonoid from Citharexylum myrianthum Cham. exhibit diuretic and potassium-sparing effect in rats. J Mol Struct 2021; 1239: 130483.
Melendez-Camargo ME, Contreras-León I, Silva-Torres R. Diuretic effect of alkaloids fraction extracted from Selaginella lepidophylla (Hook. et Grev.) Spring. Bol Latinoam Caribe Plantas Med Aromat 2014; 13(1): 92-9.
Gasparotto A Junior, Gasparotto FM, Boffo MA. et al. Diuretic and potassium-sparing effect of isoquercitrin—An active flavonoid of Tropaeolum majus L. J Ethnopharmacol 2011; 134(2): 210-5.
[] [PMID: 21163342]
Mariano LNB, Boeing T, da Silva RCMVAF. et al. Preclinical evaluation of the diuretic and saluretic effects of (-)-epicatechin and the result of its combination with standard diuretics. Biomed Pharmacother 2018; 107: 520-5.
[] [PMID: 30114635]
Tiwari S, Sirohi B, Shukla A, Bigoniya P. Phytochemical screening and diuretic activity of Allium sativum steroidal and triterpenoid saponin fraction. Int J Pharm Sci Res 2012; 3(9): 3354.
Bracci A, Amat AG, Maione F, Cicala C, Mascolo N, De Feo V. Diuretic activity of Lophophytum leandri. Natural Product Communications 2012; 7(1): 1934578X1200700112.
Yuliana N, Khatib A, Link-Struensee A. et al. Adenosine A1 receptor binding activity of methoxy flavonoids from Orthosiphon stamineus. Planta Med 2009; 75(2): 132-6.
[] [PMID: 19137497]
Rebuelta M, Vivas JM, San Roman L. Study of the diuretic effect of different preparations of the flowers of Sambucus nigra L. Plantes Medicinales et Phytotherapie 1983; 3: 173.
Jouad H, Lacaille-Dubois MA, Lyoussi B, Eddouks M. Effects of the flavonoids extracted from Spergularia purpurea Pers. on arterial blood pressure and renal function in normal and hypertensive rats. J Ethnopharmacol 2001; 76(2): 159-63.
[] [PMID: 11390130]
Alonso-Castro AJ, Arana-Argáez VE, Deveze-Alvarez MA. et al. Anti‐inflammatory and diuretic effects of the diterpene ent‐dihydrotucumanoic acid. Drug Dev Res 2019; 80(6): 800-6.
[] [PMID: 31243798]
Venkateshwarlu E, Sharvanabhava BS, Dileep P. et al. Evaluation of diuretic and antidiabetic activity of esculin. Iranian J Pharmacol Ther 2015; 13(1): 40-5.
Moreno E, Gayosso JA, Montejano JR. et al. Geraniin is a diuretic by inhibiting the Na + -K + -2Cl − cotransporter NKCC2. Am J Physiol Renal Physiol 2018; 314(2): F240-50.
[] [PMID: 29046296]
Hakim EM, Sivak KV, Kaukhova IE. Evaluation of the diuretic effect of crude ethanol and saponin-rich extracts of Herniaria glabra L. in rats. J Ethnopharmacol 2021; 273: 113942.
[] [PMID: 33610714]
Lopera-Londoño C, Melan C, Vásquez J, Serna A, Patiño AC, Benjumea DM. Diuretic activity of the flavonoid pinostrobin previously identified from the species Renealmia alpinia. International Pharmacy Acta 2023; 6(1): e4.
de Souza P, da Silva RCV, Mariano LNB, Dick SL, Ventura GC, Cechinel-Filho V. Diuretic and natriuretic effects of hesperidin, a flavanone glycoside, in female and male hypertensive rats. Plants 2022; 12(1): 25.
[] [PMID: 36616153]

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