Clearance of inulin,diodrast, chloride and phosphate under mercurial diuresis: Intensive study of a patient in severe cardiac failure

A patient in severe cardiac decompensation was subjected to clearance tests of inulin, diodrast, chloride and phosphate over a period of eight weeks. The urinary output, daily weight and clearance figures, together with the $\text{U}\text{P}$ ratios of inulin, chloride and phosphate were tabulated. The $\text{U}\text{P}$ chloride was plotted against the $\text{U}\text{P}$ inulin in order to assess the reabsorption of chloride in the distal tubules in terms of water reabsorbed by the proximal tubules. The same was done in the case of phosphate.Similar determinations were made under conditions resulting from the administration of mercupurin, and the data were plotted and compared with data drawn from experiences with normal individuals in varying degrees of water diuresis.Evidence was found to support the idea that the oliguria of cardiac decompensation is not the function of a decreased filtration rate, and that the large outputs associated with mercurial diuresis are not the results of an increase in filtration rate. It, therefore, appeared probable that the fluid retention of cardiac decompensation should be considered, as referring directly to the renal tubules, and that the action of the mercurial diuretic was first on the proximal tubules and second and specifically upon the behavior of the distal tubules toward chloride.