Lennert T, Luft F C
Department of Pediatrics, Klinikum Benjamin Franklin, Free University of Berlin, Germany.
Am J Kidney Dis. 1997 May;29(5):777-80. doi: 10.1016/s0272-6386(97)90134-7.
"Wisdoms of today become the follies of tomorrow," remarked none other than Franz Volhard, who first classified renal disease. In earlier times, nephrologists relied less on controlled randomized prospective trials and more on common sense. One such notion was the idea that kidneys could be "rested" by requiring them to make less urine. Particularly in Germany early in this century, patients with chronic renal disease were advised to go to Assuan in Egypt, where the warm sunny weather and low humidity decreased their urinary output. Thus, a "vacation" was prescribed for sick kidneys, and indeed, early in his career Volhard also supported this notion. In a small but excellent study, Loewy, Wohlgemuth, Bickel, and Schweitzer concluded that a decreased urinary output, rather than decreasing renal work, would require a considerable increase in concentration of excreted solutes, a task that patients with renal insufficiency would not be likely able to meet. These findings, as well as the observation that renal patients often failed to return from Egypt, caused Volhard to change his mind.
“今日之明智，明日即成愚行”，这正是最早对肾脏疾病进行分类的弗朗茨·福尔哈德所说。在更早的时候，肾病学家较少依赖对照随机前瞻性试验，更多地依靠常识。其中一个观念是，通过减少肾脏产尿量可以让肾脏“得到休息”。特别是在本世纪初的德国，慢性肾病患者被建议前往埃及的阿斯旺，那里温暖晴朗的天气和低湿度会减少他们的尿量。因此，给患病的肾脏开出了“休假”的药方，事实上，在其职业生涯早期，福尔哈德也支持这一观念。在一项规模虽小但很出色的研究中，洛伊、沃尔格穆特、比克尔和施韦策得出结论，尿量减少非但不会减轻肾脏的工作负担，反而会使排泄溶质的浓度大幅增加，而肾功能不全的患者很可能无法完成这项任务。这些发现，以及肾病患者常常未能从埃及返回的观察结果，促使福尔哈德改变了想法。
