Albuminuria

“ Albuminuria at the time of the menarche is a disease of development which is not infrequently met with in chlorotic girls, as in adolescent boys. On examination of the urine in such young girls we detect the presence of a variable quantity of albumin, which is present especially after severe physical exertion, mental application, or emotional excitement, whilst the urine secreted at night is usually free from albumin. ”

“ It is true that serious interference with the elimination of urea and other nitrogenous matters may occur without the coexistence of albuminuria, so that it is impossible to deny that severe nervous symptoms may result from impaired renal activity even when the urine contains no albumen. ”

“ Thus, fatiguing exercise will bring it on in some persons, and the urine of a body of soldiers if examined late in the day after severe drill shows a much larger proportion of albuminurics than if examined after rising. The urine of the pedestrian Weston is said to have contained not only albumen, but casts. It is certainly not true that fatiguing exercise will cause albuminuria in everybody, and it is not claimed, even by those who report these and similar cases, that they prove albumen to be a normal constituent. ”

“ Bain and Edgecombe, discussing gouty albuminuria, state that the magnesia water of Harrogate, in combination with the old sulphur, has a marked effect in reducing the absolute amount of albumen in the urine, e.g., from one-fourth by volume to a mere trace. They add, that if the specific gravity of the urine be low chalybeate water is indicated with, if necessary, a morning aperient draught. If glycosuria and albuminuria co-exist, the “sulphur waters may be tried tentatively” as the specific gravity does not help us in these cases. ”

“ How far alteration in the capillaries and epithelium is in each case concerned in the production of albuminuria it is often impossible to say, since any alteration in these elements which can be observed after death is almost certain to be complicated with lesions which can disturb the local circulation. ”

“ Regular movements of the bowels usually will prevent piles. Piles will not usually give rise to much trouble unless constipation exists.
Albumin in the urine. (Albuminuria) .—While the urine of about six to ten per cent of all pregnant women contains albumin, the appearance of this symptom should always be regarded with apprehension. Women who are in their first pregnancy are most frequently affected. If the woman has had disease of the kidneys before her pregnancy began this symptom will likely appear in the early months ”

“ Pathological albuminuria is most constant and the albumen is most abundant with acute and chronic parenchymatous nephritis, with acute diffuse nephritis, and with the large white variety of chronic diffuse nephritis. It is least constant and least abundant with the atrophic variety of chronic diffuse nephritis, with some waxy kidneys, with interstitial nephritis, and with chronic congestion of the kidney. ”

“ If albumen appears, it makes the prognosis more grave, but it should cause no despair. Mahomed and the early observers thought that kidney disease was almost inevitable sooner or later, but further experience has shown us that many cases live for years and then die38 without albuminuria. In other cases it is often transient and responds to treatment. ”

“ The influence of many well-recognized pathological states in bringing about venous stasis, and that delay of the blood in the renal—and more especially the Malpighian—vessels which seems the most essential factor in the secretion of albumen, is well known, and its recognition is of much importance in diagnosis and prognosis, since the unfavorable signification of albuminuria in certain cases is liable to be overrated, and a diagnosis of chronic renal disease made to depend upon symptoms which really belong to some other affection. ”

“ In addition to other diseases, the result of drain poison, the author has met with several cases of albuminuria which he believes can and does under continued exposure to the sewer poison, result in incurable disorganization of the kidneys. He thinks that, in the absence of other probable exciting causes of albuminuria, the possibility of sewer poisoning should be constantly borne in mind. It is needless to dilate upon the importance of discovering the exciting cause of a disease so serious in its consequences as nephritis. ”

“ In the severer cases a well-marked parenchymatous nephritis exists; but it should be distinctly borne in mind that if every instance of albuminuria in pregnancy is due to nephritis, it is certainly a form of the disease which may lead neither to severe symptoms nor to chronic disease. On the other hand, the appearance of albumen in the urine of a pregnant woman, though not necessarily calling for active interference of any kind, should always be a danger-signal, and put the physician on the lookout for other indications of actual renal disease. ”

“ The cirrhotic kidney is distinguished from the other forms by the abundant aqueous urine, containing comparatively little albumen—none at all at times—cardiac hypertrophy, and hard pulse. In the differential diagnosis of chronic tubal nephritis and the kidney of pregnancy chief reliance must be placed upon the history of the case and the course of the affection. Albuminuria is a very inconstant symptom of the lardaceous kidney, especially in the beginning and ultimate stages of the disease. ”

“ Doubt may occasionally arise as to the diagnosis between a congested kidney consequent upon valvular disease of the heart and an interstitial nephritis with hypertrophy of the heart. In the latter case, however, the urine, although containing albumen, is usually much more copious and of low specific gravity. Diminished power of the heart without valvular lesion may have as a consequence albuminuria which disappears if the heart recovers its vigor. ”

“ But he was the first to draw attention to the presence of albuminuria in diphtheria, showing that the disease was more than a local affection of the throat and nose, his chief claim to remembrance lies in his active control of the British Medical Association when that body still had its central offices in the midlands. ”

“ Albuminuria is therefore a cause, not a result, of renal disease. [93] M. Simmola founds these views on a series of experiments on animals. He injected into the blood-vessels various substances containing albumen, as white of egg, milk, and blood-serum, with the result of inducing artificial Bright’s disease. White of egg was most active in this way.”
[93] And this only one of the hundred and one instances, in medical practice, of “cart before the horse,” which may make the difference of life or death with every patient under treatment! ”

“ Thus we find albuminuria and casts, and even signs of a serious inflammation of the kidneys, in different infectious diseases, and even after tonsillitis; also after other toxic conditions caused by the secretion of toxic products in the body from certain ductless glands, such as the sexual glands during puberty and the thyroid gland in Graves’s disease. Likewise in certain diseases where waste products of metabolism cause uric acid to be formed in large quantities, as also in diabetes, where a quantity of other toxic products, besides uric acid, are produced. ”

“ The kidneys may become affected in various ways. Albuminuria is not always of significance, as it occurs in severe and mild cases alike, both before and after tracheotomy, and therefore is not connected always either with the height of the fever or the degree of dyspnoea; at times it disappears in a few days, in other cases it is of longer duration. It is not invariably complicated with changes in the kidney, neither do we always discover casts or degenerated epithelial cells in the urine. ”

“ Albuminuria and icterus also occur.
The lesions are the same as those of arsenical poisoning—viz., stomatitis, pharyngitis, and gastro-enteritis. The specific changes consist in fatty degeneration of the liver and kidneys, and the peculiar odour resembling garlic exhaled by the flesh.
Death is a consequence of deoxygenation of the blood, which appears black, and when spectroscopically examined reveals only the lines of reduced hæmoglobin.
Treatment. Oil and milk dissolve phosphorus and render it more easily assimilable; they should never be administered. ”

“ Therefore, the morning urine after a heavy dinner of the night before contains the largest amount of lithates. Albuminuria is occasionally a symptom of indigestion in the bowel. The eating of cheese or pastry in excess may cause it.13 Seminal emissions at night frequently occur. The action and reaction upon each other of this perversion of the sexual function, the indigestion, and the mental disorder, reduce the poor sufferer to a most pitiable condition of despondency and prostration.14 ”

“ The association of albuminuria with neurosis in childhood has been noticed by many observers. The gastric and intestinal symptoms are especially characteristic. If the condition of the children is not materially improved, and if the symptoms, both of the physical defect and of the nervous disturbance, are not cut short, we may predict that in adult age their lives will be made miserable by a variety of abdominal symptoms dependent both on the vasomotor disturbance and upon the accompanying neurosis. ”

“ Urea is usually present in great excess. Hippuric and even uric acid are usually present but not in excess. When the disease has advanced to nephritis the albuminuria is complicated by the presence of casts of the uriniferous tubes, renal epithelium, white and even red blood globules.
During the violence of the attack there is no disposition nor leisure to eat, but when the more violent symptoms abate appetite is usually manifested. There may be more or less paresis of both bowels and bladder, so that neither fæces nor urine is passed yet in other cases both are discharged spontaneously. ”

“ The urea and uric acids represent the final result of the breaking down in the body of nitrogenous substances, of which albumen is the type.
Unusual constituents of the urine are albumen, sugar, and bile. When albumen is present in urine, it often indicates some disease of the kidneys, to which the term albuminuria or Bright’s Disease is applied. The presence of grape sugar or glucose indicates the disease known as diabetes. Bile is another unusual constituent of the urine, appearing in jaundice.
The bladder is situated in the pelvic cavity or in the lowest part of the abdomen. ”

“ We hold, with Professor Senator, that the permanent presence of such elements in the urine is the proof of the fact that the kidneys are not in a normal condition. Even the orthostatic albuminuria of quite healthy persons, which, as its name implies, only occurs when such persons have been standing for a time in an upright position, has been considered by Senator as an expression of the existence of certain changes in the kidneys. ”

“ The urine is usually scanty and high-colored during the height of the fever, especially in the severer forms of the disease. Its specific gravity is high, and it contains a large amount of solids, especially of urea. With the fall of the temperature it rapidly increases in quantity, and is very apt to let fall a copious lateritious sediment on cooling. According to Parkes,18 who closely observed six cases with the view of determining this question, albuminuria does not occur at any stage of the disease. ”

“ In general the capacity of the heart in such individuals is indeed sufficient to maintain the circulation through the kidneys; but as soon as the functional activity of the heart is more strongly taxed and the energy of the circulation consequently declines, albuminuria occurs—and occurs all the more readily in consequence of the fact that, the hæmoglobin-richness of the blood having been lowered by the customary anæmia, the epithelium of the renal glomeruli is badly nourished and functionally inadequate. ”

“ These phenomena are much more prominent when bacterial infection has taken place, and it seems probable that they are to be attributed chiefly to the infection, as they have become less frequent and less severe since burns have been treated like other breaches of the surface. Albuminuria is a fairly constant symptom in severe burns, and is associated with congestion of the kidneys. ”

“ There can be no doubt but we have here a most important aid in the treatment of consumption, not only, but of all ill-conditions of the physical man. But the deep, full breathing that comes from having exercised vigorously is best of all (see page 84) .
2 [NOTE ON BRIGHT’S DISEASE.]
How to Eat Meat.—In the chapter on this subject, I have taken the position that Albuminuria results from: (1) excess in diet; (2) the use of foods that can not, or are not properly masticated and insalivated, as mush, or bread wet and washed down with any sort of artificial fluids, gravy-drowned vegetables, etc. ”

“ The cause of this albuminuria of puberty is according to von Leube in part disordered hæmatopoiesis, in part a slight degree of cardiac insufficiency with a tendency to stasis. At the time when the processes of development and the growth of the body in height are most active, there is not a corresponding increase in the energy of hæmatopoiesis, and the heart also fails to keep pace with the growth 94of the body and to meet the demands thus made upon it by vigorous growth and increased energy. ”

“ Its specific gravity ranges between 1008 and 1018; the mineral salts present are the same and in about the same proportion as those of blood, nor do they vary with the position of the exudation. The quantity of albumin, however, depends much on the position of the fluid, and slightly on the underlying disease. In oedema the fluid contains only traces, whereas a pleural or peritoneal effusion is always highly albuminous. Also an effusion due to heart disease contains more albumin than one due to kidney disease. ”