Kidney stone

“ He can also watch the urine entering the bladder by the openings of the ureters, and determine from which kidney blood or pus is coming.
The treatment of stone in the bladder is governed by various conditions. Speaking generally, the surgeon prefers to introduce a lithotrite and crush the stone into small fragments, and then to flush out the fragments by using a full-sized, hollow metal catheter and an india-rubber wash-bottle. Even in children this operation may generally be adopted with success, the stone being crushed to atoms and the fragments being washed out to 29 the last small chip. ”

“ The soothing effect on the kidney will often relieve inflammation and irritation, should the stone be in that situation, while if in the ureter the warm fomentations will at once soothe irritation, relax spasm of the muscular coat of the canal, and favor an abundant secretion from the kidney, which, pressing on the obstructing stone, may slowly push it on into the bladder. ”

“ If it is not discoverable on gently pinching the kidney between the finger and thumb, the kidney had better be opened in its convex border and explored by the finger. Often it has happened that when a man has presented most of the symptoms of renal calculus and has been operated on with a negative result as regards finding a stone, all the symptoms have nevertheless disappeared as the direct result of the blank operation. ”

“ I must not omit acquainting you, sir, that upon opening his body, (which the uncommonness of his case required of us, for our own satisfaction as well as public good) there was found in his left kidney a nest of no less than seven stones, of the most irregular, figures your imagination can frame, and weighing together four ounces and a half, but all fast linked together, and adhering to his back; whereby they solve his having felt no greater pains upon motion, nor other of the ordinary symptoms of the stone. ”

“ The symptoms of renal calculus may be very slight, or they may be entirely absent if the stone is moulding itself into the interior of the kidney; but if the stone is movable, heavy and rough, it may cause great distress, especially during exercise. ”

“ One hundred and ninety-eight times the kidney has been removed, and 105 human lives have been saved; 83 times abscesses in the kidney have been opened, and 66 lives saved; 17 times stones have been removed from the kidney without a single death—or, in all, in the last fifteen years, 298 operations, and 188 human lives saved. Besides this, as an extension of the operation in 17 cases, in which the kidney, having no such attachments as ought to anchor it in place, was floating loosely in the abdomen and a source of severe pain, it has been cut down upon and sewed fast in its proper place ”

“ The tubules become blocked by the epithelium, and distended with the pent-up urine; this is one cause of the increase in size that the kidneys undergo in certain forms of Bright’s disease. The lesions in the tubules and in the glomeruli are not generally uniform. The interstitial tissue is always affected, and exudation, proliferation and formation of fibrous tissue occur. In the granular and contracted kidney the lesion in the interstitial tissue reaches a high degree of development, little renal secreting tissue being left. ”

“ Rupture of the kidney may result from a kick or other direct injury. Vomiting and collapse are likely to ensue, and most likely blood will appear in the urine, or a tumour composed of blood and urine may form in the renal region. An incision made into the swelling from the loin may enable the surgeon to see the torn kidney. An attempt should be made to save the kidney by suturing and draining; unless the damage is obviously past repair, the kidney should not be removed without giving nature a chance. ”

“ In the same way the kidneys can also be kept in good condition if too much meat be not taken. These eliminate the end-products of meat food, and the more of such products that pass through the kidneys, the more of them are taken from the blood and excreted by means of the fine epithelia of the kidney tubules, and thus the more is the work done by these organs; and we have mentioned that any overwork of an organ may be followed by its exhaustion. ”

“ For this reason, should the kidneys of a man be once attacked by disease, the malady is not easily expelled. For it is as though many kidneys were diseased and not merely one; which naturally enhances the difficulties of a cure.
The duct which runs to the kidney from the great vessel does not terminate in the central cavity, but is expended on the substance of the organ, so that there is no blood in the cavity, nor is any coagulum found there after death. A pair of stout ducts, void of blood, run, one from the cavity of each kidney, to the bladder ”

“ By a bath with soap the pores of the skin are better opened, as the dirt that clogs them is removed, and thus the poisonous products can be given off through the skin more easily, and the skin thereby justifies its name as chief assistant to the kidneys. It is, in fact, our second kidney. When the skin comes into greater activity through the action of the sudorific glands, a part of the solids in the urine and many harmful matters, which otherwise would make their way through the kidneys, are eliminated through the skin instead, in which manner the powers of the kidneys are economized. ”

“ When the overgrowth of fibrous tissue is considerable, the surface of the organ becomes uneven, and it is for this reason that the term granular kidney has been applied to the condition. In acute Bright’s disease the kidney is increased in size and engorged with blood, the changes described above being in active progress. ”

“ I have seen the right lobe of the liver extend into the pelvis, and come in contact with the unimpregnated uterus. It is important to remember that a kidney sometimes occupies the hollow of the sacrum; such a misplaced kidney has been removed under the impression that it was a tumour. When a kidney occupies the pelvis it lies behind the peritoneum as when it occupies its normal position in the loin. A horseshoe kidney is a fertile source of divergent opinion in diagnosis. A very large hydronephrosis simulates very closely an ovarian cyst until exposed through an abdominal incision ”

“ But more usually the organ is loose under the peritoneum, and not efficiently supported in its fatty bed. Movable kidney produces a variety of symptoms, such as pain in the loin and back, faintness, nausea and vomiting—and the function of the organ may be seriously interfered with, owing to the ureter becoming kinked. In this way hydronephrosis, or distension of the kidney with urine, may be produced. The return of blood through the renal vein may also be hindered, and temporary vascular engorgement of the kidney, with haematuria, may be produced. ”

“ For no doubt the diameter of the renal blood-vessels is augmented by their engorgement, and consequently they exert a deleterious pressure on the intervascular tissues, which will interfere with their proper nourishment. While, further, this engorgement of the renal vessels will render the kidneys more liable to the injurious effects of chills; and chills are, as is well known, the most fruitful cause of kidney disease. ”

“ Fatal terminations, however, do now and again occur, sometimes as a result of injury to the bladder-wall setting up inflammation, which extends to the kidneys, sometimes from suppression of urine. Those cases in which there has been a fatal result most frequently have been complicated with old-standing kidney disease. ”

“ Hæmorrhage from the kidnies, when attended with no pain, is owing to defect of venous absorption in the kidney. When attended with pain on motion, it is owing to a bit of gravel in the ureter or pelvis of the kidney; which is a much more frequent disease than the former. ”

“ Anaesthetics, that is, chloroform and ether, are not well tolerated when nephritis exists, and this adds to the danger of operation in such patients. No matter how simple or short the operation that is to be performed on a person suffering from kidney disease, if an anaesthetic is to be administered it would be well to prepare the patient for an untoward event that may occur.
Kidney disease is often extremely insidious. It may develop absolutely without the patient's knowledge, even though he might be deemed to be in a position to have at least some suspicion of its existence. ”

“ Toxic elements in the blood affect the kidneys in a greater or less degree, and there produce changes at first unnoticed,—at least, as long as the kidney can perform its function,—but the day arrives when, as described by Fothergill, blood depuration is imperfect, and we get many diseases which are distinctly uræmic in character, and ending in any of the so-called kidney diseases, Bright’s disease being one of the most common. ”

“ The kidney may be ulcerated, and contain grubs, as well as the liver, it being likewise a gland, but much smaller than the liver. You can injure the kidneys by food, as all water or liquids go immediately to the kidneys; sweet spices and all acids should be avoided, as they coat the kidneys, and cause the gravel; the ureter, or pipe which takes the water to the bladder, finally gets filled and obstructed, so the water cannot pass thence. ”

“ The kidneys then are big filter-glands. They, like the lungs, are made up of a mesh, or network, of thousands of tiny tubes of two kinds, one set of tubes being blood vessels, and the other set the tiny branches of the kidney tubes which finally run together to form the ureters. The urine filters through from the spongy mesh of blood tubes (capillaries) into the kidney tubes and is poured out through the ureters. It is very important that the urine should be discharged as fast as it fills the bladder, that is, about once every three hours during the day. ”

“ His Kidneys cover'd with fat, and pretty sound; only in the anterior surface of them there were found some aqueous or serous (as 'twere) abscesses, whereof one was near the bigness of a Hen-egge, with a lowish water in it, having made a roundish cavity, impressed in that kidney: whence some thought it came, that a little before his death a suppression of Vrine had befallen him; though others were of opinion, that his Vrin was suppressed upon the regurgitation of all the Serosity into the Lungs. ”

“ In this way the size, shape, and sensitiveness of the tumor can be determined, as well as its position and movability.
A movable kidney may of course present some difficulties of diagnosis from other abdominal tumors. The liver is sometimes, though very rarely, movable, and never to the same extent as a wandering kidney, and as it is pushed downward discloses its much greater bulk. The base of the gall-bladder may occasionally be quite movable, but its excursions are of a more limited radius, being of course executed only by the base and not the whole organ. ”

“ They are deeply seated in the lumbar region, one on each side of the vertebral column, at the back of the abdominal cavity, and behind the peritoneum. The kidneys measure about 4 inches in length, 21⁄2 inches in breadth, and 11⁄2 inches in thickness. The left is usually longer and narrower than the right one. The weight of the kidney is usually stated to be about 41⁄2 ounces in the male and somewhat less in the female. ”

“ In some cases of horse-shoe kidney the organs are united merely by fibrous tissue. Occasionally the two kidneys are fused end to end, with two ureters. A third variety is that where the fusion is more complete, producing a disk-like mass with two ureters. The kidneys may be situated in abnormal positions; thus they may be in front of the sacro-iliac articulation, in the pelvis, or in the iliac fossa. The importance of such displacements lies in the fact that the organs may be mistaken for tumours. ”

“ Bony tumors, however, can be readily diagnosticated; and possibly fibrous tumors, by reason of their density, may cast shadows.
Fifth.—That stones in the kidney, bladder, and gall bladder cannot be diagnosticated, either (1) because they are embedded in such parts of the body as are too thick to be permeable by the rays, or (2) are surrounded by the bones of the pelvis, or (3) are, in the case of gall stones, themselves permeable to the Röntgen rays. ”

“ For some reason or other, too technical for a layman to understand, it is a very wonderful kidney. Now it happens that a young woman physician discovered the patient with that kidney and diagnosed it. A woman surgeon operated on that kidney and removed it successfully. Then a man physician came along and borrowed it and read a paper on it at a medical convention. He is now chronicled throughout the [248] medical fraternity with the entire credit for the kidney.
“And it isn’t his. It’s our kidney,” I heard the girl doctor say with flashing eyes. ”

“ A horseshoe kidney is usually discovered only after death, and with no special frequency in cases of renal disease.
Variations in the number of the kidneys possess this point of practical interest, that diseases affecting a single organ are more dangerous than if another exists which can take upon itself extra duty. Apparent absence of one kidney may be due to atrophy, attended with very small size of the renal vessels; in which case a small mass of connective tissue is found at the upper end of the ureter, which is usually illy developed. The other kidney is usually hypertrophied. ”

“ The kidney and its pelvis form a more or less irregular rounded pouch, with the tense cylindrical tube of the ureter attached to it below. The kidney itself becomes in various degrees atrophied. In some cases it retains nearly all its secreting structure, and is merely spread out upon the surface of the sac; in others, while the pelvis is but little dilated, the true kidney substance atrophies almost completely, and becomes a mere shell enclosing a cavity continuous with the pelvis and broken up by fibrous septa into subordinate cavities representing the original calices. ”