Principles and clinical uses of diuretic therapy

Abstract

I NDUCTION OF diuresis as a therapeutic modality has long been a mainstay of medical practice. It was advocated by physicians in the Fertile Crescent for the treatment of many renal diseases. Components capable of inducing diuresis have been identified in Sumerian, Assyrian, and Babylonian pharmacopeias.’ More recently, Al-Rhazi (850-932 AD), chief physician in Bagdad in the Abbasid period, prescribed it to prevent obstruction in cases of renal papillary necrosis,’ and Ibn-Sina (Avicenna) (980-1037 AD) incorporated diuresis as an integral part of his regimen for the dissolution of kidney st0nes.j Even Withering prescribed foxglove thinking it was a diuretic. However, modern diuretic therapy finds its origins in fortuitous observations on agents first introduced as antimicrobials. Vogl in I920 reported the diuretic effect of the organomercurial merbaphenum, then a treatment for syphilis. However, mercurials proved to be highly toxic and inconvenient. The need for a safer orally effective diuretic was satisfied with a second astute observation from the field of antimicrobials. Benzothiadiazine diuretics were discovered after the observation of diuresis during antimicrobial therapy with sulphonamides. In 1957, Novello and Sprague synthesized chlorothiazide and ushered the era of widespread use of diuretics into the practice of medicine.