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Unwanted effects attributable to actions in the kidney:
Hyperuricaemia
The thiazides compete with uric acid for secretion by the anion transport mechanism in the proximal convoluted tubule. Pre-existing gout may therefore be exacerbated.
Hypokalaemia
This results from increased Na+ / K+ exchange in the collecting ducts. K+ supplements (e.g. effervescent K+ tablets) are seldom needed in the routine treatment of hypertension.
Hyponatraemia
This a result of the inhibition of the Na+/Cl- cotransporter in the distal convoluted tubule.
