G. Schreiner
Feb 1, 1958
Citations
0
Influential Citations
29
Citations
Journal
Annals of the New York Academy of Sciences
Abstract
Chlorothiazide is an organic sulfur compound of high biological activity that has aroused considerable interest because of its ability to block sodium and chloride reabsorption in the renal tubule. The basic chemical and pharmacological properties of this agent have been described elsewhere in this monograph, and need not be repeated here. Previous communications from this laboratory' have reported the effect of chlorothiazide on the edema of cirrhosis, nephrosis? congestive failure, and chronic renal insufficiency and have commented on the role of chlorothiazide as compared to that of other diuretic agents used in patients with varied renal disorders such as congenital polycystic di~ease.~ We have also noted an antihypertensive effect in one patient with salt retention in acute glomerulonephritis and, after our attention had been called to the antihypertensive properties of the drug by Freis and W i l ~ o n , ~ we have continued to note its ability to increase the potency of other antihypertensive agents in some patients whose hypertension is secondary to chronic renal disease. The present report reviews data obtained from the use of chlorothiazide on patients with renal disease. While the individual renal patient can and often does present a multiplicity of management problems, we have found it helpful to divide the indications for chlorothiazide into four principal categories: (1) edema without renal insufficiency as seen in membranous glomerulonephritis, nephrotic syndrome, mild pre-eclamp~ia,~ and functional edema; (2) edema with moderate renal insufficiency as commonly seen in the nephrotic stage of such disorders as subacute and chronic glomerulonephritis, amyloidosis, Kimmelstiel-Wilson disease, systemic lupus erythematosis, severe pre-eclampsia, acute glomerulonephritis, and pyelonephritis; (3) marked renal insufficiency where the object of therapy is an enhancement of osmotic diuresis rather than control of salt retention, which is rarely marked in such patients unless they are on the extremes of dietary intake; and (4) miscellaneous situations such as cystic disease and the control of hypertension for its own sake.