Nephrology Pearls Courtesy of Hippocrates

A cool article from this month's AJKD describes several of the Nephrology-related aphorisms originally penned by Hippocrates sometime around 400 BCE. These brief, pithy sayings probably represent the earliest attempts to understand the kidney in health and disease and the use of an examination of the urine in diagnosis.

A few of the highlights are shown below. Note that there is still some debate as to what each quote is really referring to.

1. The earliest description of casts? "When small fleshy substances like hairs are discharged along with thick urine, these substances come from the kidneys." Perhaps this describes the recognition of ATN as a cause of acute renal failure.

2. The earliest description nephrotic syndrome? "When bubbles settle on the surface of the urine, they indicate disease of the kidneys, and that the complaint will be protracted." It would be more convincing if he had also described the clinical elements of nephrotic syndrome (e.g., massive edema) but this is not mentioned.

3. On the utility of the bedside urinalysis: "We must look to the urinary evacuations, whether they resemble those of persons in health; if not at all so, they are particularly morbid, but if they are like those of healthy persons, they are not at all morbid." This little nugget is something that we all discover early on in our internal medicine residency: if a patient is admitted with an acute illness (e.g., pneumonia), the presence of concomitant renal failure is a very poor prognostic sign.

4. The earliest attempts at the diagnosis of nephrolithiasis: "In those cases where there is a sandy sediment in the urine, there is calculus in the bladder." A prehistoric "Litholink" test, if you will.

5. The discovery that uric acid-mediated disease is highly dependent on male sex hormones: "Eunuchs do not take the gout, nor become bald...A woman does not take the gout, unless her menses be stopped...A young man [boy] does not take the gout until he indulges in coition." The M:F ratio of gout in premenopausal females and age-matched males is about 8:1, but decreases to about 3:1 in those over 65 years of age.

6. Okay, so the guy's not perfect: "Venesection cures dysuria; open the internal veins of the arm."

Check out the full article if you enjoy this kind of historical stuff; it's really interesting and also offered FREE even for those without an institutional or individual subscription to AJKD.