I’ve been visiting Dubai for the past few days and I wondered about what historical contribution this region had made to the study and treatment of kidney disease. It didn’t take much to dig around and come with the answer “a lot”.… and it began a long time ago!
In an interesting article published in the Iranian Journal of Nephrology in September 2011 titled “A Critical Review of the Works of Pioneer Physicians on Kidney Diseases in Ancient Iran” Saeed Changizi Ashtiyani and colleagues review the contribution of four early pioneers - Avicenna, Rhazes, Al-Akhawayni, and Jorjani. The report contains extensive biographical information about these physicians.
“Oliguria can be due to the following causes: (1) drinking inadequate liquids; (2) body porosity; (3) effect of diarrhea on the body; (4) disability of the kidneys, resulting in impaired absorption of fluids; and (5) disability of the liver in separation of the fluid and sending it to the kidneys, so as in hepatic cirrhosis [sou of gonieh in Arabic] and dropsy state [estesgha in Arabic].”
In Hidayat, Al-Akhawayni also refers to renal atrophy (hozal), and suggests end-stage kidney disease with cachexia, polyuria, edema, and dropsy. He discusses the inflamed kidneys that might heal, form an abscess, or fail to heal and become “hard” which seems to suggest the small hardened kidneys of end-stage kidney failure. Credit for reference to hardened end-stage kidneys has been given to William Gulielmus of Saliceto when in fact it was described by Rufus of Ephesus in the 2nd century and re-stated 200 years earlier than Gulielmus by Al-Akhawayni.
For those with nephrolithiasis, Al-Akhawayni offers sage advice (for the time): “Beware that when the stone enlarges in the kidney it hinders the urine, causes intolerable pain, and may lead to mental confusion from pain. Each occasion of the pain is called an episode [the pain is intermittent]. During the episode of pain, the patient should sit in a tub of warm water in which the leaves of cabbage [Brassica oleracea], leaves of marsh-mallow [Althaea officinalis], chamomile [Anthemis nobilis], dwarf yellow [Astragalus hamosus], fenugreek [Trigonella foenum graecum], flaxseed [Linum usitatisimum], seed of mingwort [Artemisia absinthium], and star- thistle [Centaurea calcitrapa] have been brewed. And after getting out of the water tub, the back [of the patient] should be massaged gently with the oil of wallflower [Cheiranthus cheiri], and then he should jump [up and down] on one foot, or ride a horse trotting in place, or climb fast down a ladder until the stone comes out of there.”