Renal diseases in the Hippocratic era

Hippocrates and the medical school of Kos were mainly concerned with the common elements of various diseases and the accurate description of symptoms and signs, as well as their prognostic implications. In contrast, the medical school of Knidos (in neighbouring Asia Minor) and its chief member Euryphon were interested in the systematic classification of diseases according to the systems involved. Galen mentions that Knidian physicians were familiar with four renal diseases, probably the same described in the book About Inner Sufferings, whose author is not known with certainty; most investigators attribute it to the Knidian school (5th century BC), while others consider it to be a Hippocratic work. Both theories are logical and possible, since Hippocrates himself was familiar with the work of the Knidian school and a rival of Euryphon. The first renal disease described in the book is nephrolithiasis with renal colic. Its description is considered a classic one and it is well known for its accuracy and clarity. The second disease corresponds to renal tuberculosis, while the remaining two are somewhat unclear, the third resembles either renal vein thrombosis or bilateral papillary necrosis. The fourth disease, described in the greatest detail of all, corresponds to a chronic suppurative renal infection or a sexually transmitted urethritis, complicated by renal involvement. Some statements concerning treatment follow; they consist of diet modification, physical exercise, ingestion of herbal extracts and surgery, as a last resort. It is therefore evident that Hippocrates is the father of clinical nephrology and that Hippocratic medicine lies at the root of the development of clinical nephrology.