Kidneys on vacation: the notion of renal work and the introduction of nonpharmacological therapies.
"Wisdoms of today become the follies of tomorrow," remarked none other than Franz Volhard, who first classified renal disease. In earlier times, nephrologists relied less on controlled randomized prospective trials and more on common sense. One such notion was the idea that kidneys could be "rested" by requiring them to make less urine. Particularly in Germany early in this century, patients with chronic renal disease were advised to go to Assuan in Egypt, where the warm sunny weather and low humidity decreased their urinary output. Thus, a "vacation" was prescribed for sick kidneys, and indeed, early in his career Volhard also supported this notion. In a small but excellent study, Loewy, Wohlgemuth, Bickel, and Schweitzer concluded that a decreased urinary output, rather than decreasing renal work, would require a considerable increase in concentration of excreted solutes, a task that patients with renal insufficiency would not be likely able to meet. These findings, as well as the observation that renal patients often failed to return from Egypt, caused Volhard to change his mind.
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Department of Pediatrics, Klinikum Benjamin Franklin, Free University of Berlin, Germany.
Luft
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D004534:Egypt; D005858:Germany; D049673:History, 20th Century; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007674:Kidney Diseases / Q000266:history* / Q000628:therapy; D009398:Nephrology / Q000266:history