EFFECTS ON THE KIDNEY 917 



pendent on glucose, it was suggested that the inhibitions of transintestinal 

 transport are perhaps all the result of interference with glucose uptake into 

 the cells. This does not explain the immediate responses, which may be 

 due to the direct effect of Hg++ on the cell membranes. Indeed, all the 

 changes observed may arise from modifications in the permeability prop- 

 erties of the lumenal membranes. 



EFFECTS ON THE KIDNEY 



The clinical effectiveness of the mercurials in certain edemas has stimulat- 

 ed much investigation directed at discovering the mechanism by which diu- 

 resis is produced. It is now clear that the action is on tubular transport 

 processes. Since these transports are mainly active and depend on tubular 

 cell metabolism, as well as on certain specific carrier and enzyme systems, 

 we shall be primarily concerned with the possible effects of the mercurials 

 on renal metabolism as a basis for their diuretic activity. The pharmacology 

 textbooks and recent reviews (Beyer and Baer, 1960; Farah and Miller, 

 1962; Kessler, 1960; Mudge and Weiner, 1958; Orloff and Berliner, 1961; 

 Pitts, 1958, 1959) cover the general renal actions of the mercurials and also 

 discuss many of the controversial points. We shall confine ourselves here to 

 a summary of these actions and then proceed to the mechanisms which may 

 be involved in the alteration of the transport systems. The structures of the 

 four most common mercurial diuretics used experimentally are shown in 

 their ionic forms. The preparations provided for clinical use are complexed 

 with different ligands (OH^, Cl^, thioacetate, or theophylline), but once 

 introduced into the body or experimental media, the mercurials usually 

 establish new equilibria with the available ligands, as discussed previously 



OCHjCOO" H3C CH3 



r,:^ OCH, bOC^N (-CH, OCH3 



L ))— CONH-CH2— CH— CHj— Hg V— CONH— CH— CH— CH2— Hg" 



Mersalyl (Salyrgan) Mercurin (mercaptomerin, Thiomerin) 



OCH3 

 I 

 HjN— CONH— CHj— CH— CH2 — Hg 



Chlormerodrin (Neohydrin) 



OCH3 

 I 

 OOC— CH,CH,— CONH— CONH— CH,— CH— CHj— Hg 



Meralluride (Mercuhydrin) 



