For decades, spironolactone was favored over loop diuretics. Why? Known hyperaldosteronism in cirrhosis; Observed efficacy of spironolactone as a single agent; In 1981, Fogel et al. published a randomized controlled trial comparing 3 regimens: Furosemide alone “Sequential spironolactone” (starting with spironolactone and increasing dose, and only adding lasix if no response to max. Loop Diuretics Volume depletion Acute interstitial nephritis (rare) Loop diuretics (furosemide & bumetanide) preferred as thiazides less effective if GFR 25ml/min. However thiazides can potentiate the effects of loop diuretics If volume depleted, consider with holding Potassium sparing diuretics amiloride, eplerenone and spironolactone Volume depletion Hyperkalaemia Stop if AKI Statins May.