This section is from the book "Materia Medica And Therapeutics: An Introduction to the National Treatment of Disease", by John Mitchell Bruce. Also available from Amazon: The pharmacology and therapeutics of the materia medica.
So many of the disorders of the urine are but expressions of derangement of the blood and of the great organic functions, that it is hardly necessary to say that natural recovery constantly occurs. Conversely, improvement in the condition of the urine is an evidence of the spontaneous return of the stomach, intestines, liver, heart, etc., to the normal state when the causes of their disorder have been removed.
The kidney possesses several provisions for natural recovery. It meets increased work by increased action; compensatory hypertrophy of one kidney occurs if the other kidney fail; and a close vicarious relation exists between the kidney and the skin and bowels. The practical therapeutist closely follows these natural methods in arranging his treatment.
A careful consideration of the four preceding sections specially impresses two facts upon us. First, the rational treatment of any case of renal or urinary disorders must be founded upon an appreciation of the influences of other organs upon the kidneys; and, secondly, treatment may be as often directed to the kidneys for diseases of other organs as when they are themselves at fault: diuretics will be as frequently employed to relieve the heart as to stimulate the cells of the kidney.
(A) Renal Congestion From Heart Disease. This may be taken as the type of renal disorder from diminished blood-pressure, whatever its cause; and such being the pathology of the condition, the line of rational treatment is obvious. To remove the cause we must restore the normal relations of the general circulation, that is, strengthen the heart, fill and keep full the arteries, and empty the veins. How this is to be done has been already discussed in chapter x (The Circulatory System)., and need not be repeated here. We are now able to estimate the value of two sets of diuretic remedies which are successfully employed in such cases, namely, the cardio-vascular diuretics, and the saline diuretics. Digitalis and Squill exactly fulfil the indications just mentioned as regards the heart, the arteries, and the veins. They increase the cardiac vigour and the period of rest; sustain the arterial tension at a moderate height; and empty the veins forwards by prolonging the diastole. At the same time, partly by these effects and partly by their local action on the renal vessels, they cause a true diuresis from the Malpig-hian bodies, and increase the force of the circulation through the renal veins. Ammonia, Alcohol, or Scoparium, may be combined with these drugs; and here it may be remarked, once for all, that combination is peculiarly useful in diuretics. Saline purgatives also assist this action. Thus Sulphates of Soda and Magnesia, Acid Tartrate of Potash, Tartrate of Soda and Potash, Acetate of Potash, Citrate of Potash or Ammonia, are, in the first place, saline purgatives, thus relieving general venous congestion; and, secondly, act upon, the renal epithelium, draining the over-distended venous plexus, and accelerating the circulation through the glomerulus. In other instances dilators of the renal vessels may be combined with these remedies, including Juniper and Spirit of Nitrous Ether. (b) Disorder or disease of the kidney in association with excessive blood pressure; Bright's disease with contracted kidney. -In the early stages of this disease, when its cause may be discovered in indulgence in food and alcohol, or disorder of the liver, the treatment consists in a thorough reform of diet, free purgation, and elimination generally. Mercurial purgatives followed by salines are especially valuable. In the more advanced and grave form of high arterial tension, the cause is usually beyond our power. All that can then be done is to counteract the cause, remove its evil effects, and treat symptoms. The food should be moderate in quantity, and chiefly non-nitrogenous; stimulants must be avoided; moderate rest of body and mind insured; and various drugs administered. We are unfortunate in possessing but few medicinal means of reducing peripheral resistance for any length of time without depressing the heart; but the Iodide, Chlorate, Nitrate, and other salts of Potash, Nitrite of Soda, Belladonna, and its allies may be tried. Warmth is very essential in these cases.
(A) Urinary Derangements From Nervous Disorder Or Disease. The treatment employed here must be entirely directed to the nervous system. Bromide of Potassium, Valerian, and other anti-spasmodics, including moral treatment, will relieve hysterical diuresis; and Opium and Ergot are successful in many cases of polyuria of obscure and probably nervous origin.
(b) Local vascular disease.-If the emulgent veins are obstructed by abdominal enlargement, this must be immediately removed, if possible - by tapping the peritoneum, for example, or by inducing premature labour. In disease of the renal vessels we can do but little by way of direct treatment beyond relieving symptoms as they arise; regulating the flow of urine as well as possible, especially stimulating it if it threaten to become deficient; and removing the excrementitious products by the bowels and skin, when the specific gravity falls.
3. Disease of the tubules; "Acute Desquamative Nephritis" "Large White Kidney."This is the form of kidney disease in which there is the greatest or most constant danger of deficient excretion, and of the consequences of the same throughout the system. The indications for treatment are obvious. We must relieve the diseased cells of as much work as can he safely dispensed with by the blood and tissues. The rational methods of relieving the renal epithelium are: (1) by reducing the food in quality and richness; and (2) by diverting the excrementitious products to other channels. Hydragogue purgatives are especially valuable in this form of Bright's disease; and the warm air or vapour or water bath, warm drinks, and Jaborandi, will successfully relieve the kidneys by perspiration. Renal stimulants, such as the saline and specific diuretics, might, on the other hand, exhaust the cells, already weakened by disease; but in certain cases they are highly useful even in this condition, for they may exert that amount of stimulation on the renal cells which, on the principle of alteratives in general, will lead to their restoration. If we believe that the tubules are blocked by cellular and inflammatory products, we must clear them by a system of flushing, or diuresis. For this purpose Distilled Water is the best diuretic; Digitalis and Squill are also valuable, as producing but little local irritation, and tending to prevent venous congestion.
In this or in any other form of renal disease, urgent symptoms of uraemia must be quickly relieved by venesection, the administration of Chloroform, free purgation, and, if possible, profuse diaphoresis. The anaemia generally demands Iron in some form.
Obstruction In The Urinary Passages. The most common cause of this serious disease, namely, stricture of the urethra, is fortunately accessible, and amenable to surgical treatment. When the obstruction is above the bladder it is very rarely bilateral, and the unaffected kidney takes on the double function of the two.
Disorders Of The Blood, Liver, And Digestion; Gravel And Calculus. The immediate treatment of these secondary disorders of the liver, in their early stage, has been already suggested: careful low dieting, and the occasional administration of chola-gogue purgatives, stomachics, and antacids. If gravel or calculus have actually formed, several other measures are still open to us, whilst the same line of treatment is persevered in to prevent further growth. We may attempt to dissolve the stone in situ by the continuous admistration of Citrate of Potash, or of acids, as the nature of the calculus demands, and relieve pain, haemorrhage, mucous and purulent discharges on general principles.