Diuretic effect of mannitol in nephrotic edema.

Abstract

Abstract Mannitol administered intravenously (an osmotic diuretic) has been used in combination with Thiomerin (a mercurial tubular-blocking diuretic) to induce diuresis 12 times in 10 cases of recurrent nephrotic syndrome in children. The data clearly demonstrate that this combination results in acute, marked increases of urinary volume, Na, and Cl limited to the 6 hour treatment periods and consequent weight (edema fluid) losses. Increased losses of K were insignificant. By comparison with the diuresis from Thiomerin administered alone on the preceding day, the contribution of mannitol to the combined diuretic effect could be discerned. The diuretic contribution of mannitol was greatest in those cases with the poorest responses to the tubular-blocking (mercurial) diuretic administered alone. In cases with no response to Thiomerin alone, mannitol plus Thiomerin elicited excellent diuretic responses. The diuretic mechanisms involved are discussed. The general principle is suggested that the proper role of an osmotic diuretic is in combination with tubular-blocking diuretics when patients are found to be refractory to them (whether used singly or in combinations). Data are presented to demonstrate the safety and effectiveness of mannitol combined with a mercurial diuretic in the treatment of the nephrotic syndrome. Treatment with osmotic diuretics was for symptomatic relief of edema and was totally independent of and without effect upon the underlying disease process.