Nephridium

“ The gonad ducts of Lumbricus, &c., must perform one function of nephridia; they must convey to the exterior some of the coelomic fluid with its disintegrated products of waste. There is no possibility that sperm and ova can escape by these tubes not in company with coelomic fluid. In the case of many Oligochaeta where there is no vascular network surrounding the nephridium, this function must be the chief one of those glands, the more elaborate process of excretion taking place in the case of nephridia surrounded by a rich plexus of blood capillaries. ”

“ Internal opening of nephridium into the body-cavity (lateral compartment) . s. Vesicle of segmental organ. s1. Portion of segmental organ of 4th and 5th legs, corresponding to vesicle of the other nephridia. s.c.1. First or external portion of coiled tube of nephridium, lined by columnar epithelium with small nuclei; the cells project for very different distances, giving the inner boundary of this region a ragged appearance. ”

“ In Nereis there is in each segment, in addition to the pair of nephridia, a pair of "dorsal ciliated organs" (Goodrich) (cil.org in Fig. 124) . Each appears as a wide-mouthed funnel, greatly folded, and without any permanent outlet. But it is possible that these organs function as genital ducts, and that the external aperture will make its appearance temporarily at the period of maturity. This "dorsal ciliated organ" has not been met with in allied genera—such as Eunice, Nephthys, Polynoë, Glycera—where the nephridium is a wide tube, and serves as a genital duct. ”

“ In acute and chronic parenchymatous nephritis the quantity is usually very large. In chronic interstitial nephritis it is small—frequently no more than a trace. It is small in cloudy swelling from toxins and drugs, and variable in renal tuberculosis and neoplasms. In amyloid disease of the kidney the quantity is usually small, and serum-globulin may be present in especially large proportion, or even alone. Roughly distinctive of serum-globulin is the appearance of an opalescent cloud when a few drops of the urine are dropped into a glass of distilled water. ”

“ Extreme congestion of the kidneys may be produced by exposure to cold, owing to some intimate relationship existing between the cutaneous and the renal vessels, the constriction of the one being accompanied by the dilatation of the other. Infective diseases, such as typhoid fever, pneumonia, scarlet fever, in fact, most acute specific diseases, produce during their height a temporary nephritis, not usually followed by permanent alteration in the kidney; but some acute diseases cause a nephritis which may lay the foundation of permanent renal disease. ”

“ The other kind of nephritis, or inflammation of the interior part of the kidney, generally arises from the pain occasioned by the stimulus of a stone entering the ureter from the pelvis of the kidney; and, which ceases when the stone is protruded forwards into the bladder; or when it is returned into the pelvis of the kidney by the retrograde action of the ureter. The kidney is nevertheless inflamed more frequently, though in a less degree, from other causes ”

“ The chief symptoms may be grouped as follows:—
Salivation, indigestion and tympanites, nausea, vomiting, diarrhœa, and (especially) intense polyuria: the kidney may be irritated to such a degree as to produce albuminuria and hæmaturia. Intense dulness and general weakness precede death, which sometimes occurs in four to twelve hours after the poison has been taken.
The lesions are to be found in the digestive and urinary apparatus. The kidneys are congested and hypertrophied, or present changes indicating epithelial nephritis. The ureters and the bladder may show similar lesions. ”

“ The stroma of the kidney is infiltrated with serum, pus-cells, and blood.
ETIOLOGY.—Most of the cases of acute diffuse nephritis occur after exposure to cold or as a complication of scarlatina.
SYMPTOMS.— (1) The Idiopathic Cases.—Of these we may distinguish two sets of cases. In the first set of cases the invasion of the disease is acute. A person who has previously been usually in good health, after exposure to cold and wet will be suddenly attacked with rigors, a febrile movement, and pain in the back. ”

“ Hyaline casts are the least significant of all the casts, [p. 115] and occur in many slight and transitory conditions. Small numbers are common following ether anesthesia, in fevers, after excessive exercise, and in congestions and irritations of the kidney. They are always present, and are usually stained yellow when the urine contains much bile. While they are found in all organic diseases of the kidney, they [p. 116] are most important in chronic interstitial nephritis. Here they are seldom abundant, but their constant presence is the most reliable urinary sign of the disease. ”

“ These lesions depend on the extent, intensity, and duration of the inflammatory attack, whatever the primary causes. All the constituent tissues of the kidney may be affected, simultaneously or individually: the Malpighian corpuscles, the convoluted tubules, the collecting tubules, or the interstitial connective tissue.
Causation. Cold seems to be an important factor. All acute or chronic intoxications in which the toxic principles are eliminated by the kidneys, such as poisoning by cantharides, fermented beet pulp, young shoots of trees or toxic plants, may cause acute nephritis. ”

“ A hydatid cyst might counterfeit a hydro-nephrosis, but instances of this affection having its primary seat in the kidney are of extreme rarity. An ordinary cystic kidney is most likely to be connected with chronic diffuse interstitial nephritis, which will have made itself manifest by the usual symptoms, and is moreover unlikely to attain the dimensions of a large or even moderate hydro-nephrosis. In a thin person the ureter might, if felt dilated through the abdominal walls, clear up the diagnosis. ”

“ Symptoms of atrophy of the kidney are necessarily those of suppression of urine, with, in certain cases, the passage of casts of the uriniferous tubes and of crystals of salts. There are, however, no absolutely pathognomonic symptoms. When the kidney can be reached through the flaccid walls of a comparatively empty abdomen, or through the rectum, its hard, shrunken condition may assist in diagnosis.
Treatment is not successful in advanced cases. Prevention is to be sought by obviating or treating the conditions on which the atrophy depends. Nephritis must be treated on general principles. ”

“ On the other hand, when suppurative nephritis tends to develop slowly and assume a chronic form, lesions of pyo-nephrosis gradually develop, and are identical in appearance with those of hydro-nephrosis, except that the ureters, the pelvis and the dilatations corresponding to the lobules, are filled with pus.
Fig. 231.—Leaf lard around kidney of pig.
Diagnosis. The diagnosis is not very difficult. The urinary trouble and the composition of the urine itself always arouse suspicion. ”

“ When the pathologic conditions have no definite relation to each other they should be classified separately. If a section of kidney shows cloudy swelling, congestion, œdema, small-celled infiltration, hæmorrhage and casts, these different conditions would all be included in the diagnosis of an acute parenchymatous degenerative nephritis. If the general picture corresponds to that of tuberculosis, syphilis, neoplasm, etc., the various associated changes need not be considered alone, but the broad and comprehensive diagnosis should be expressed in as concise terms as possible. ”

“ 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. ”

“ Recovery.—The prognosis is favorable in uncomplicated cases. It also depends upon the character of the epidemic type of the disease. In England it varies from thirteen to fourteen per cent. In this country it is sometimes as low as two to four per cent. The kidney trouble is always feared for it may result in uremia and death, or the acute may be followed by chronic nephritis or Bright's disease, which will ultimately prove fatal.
Sanitary Care of Room and Patient.—If you are exposed to this disease what can you do? If a child, it must be put in a room by itself. ”

“ Small, round, or polyhedral cells are about the size of pus-corpuscles, or a little larger, with a single round nucleus. Such cells may come from the deeper layers of any part of the urinary tract. They are uncommon in normal urine. When they are dark in color, very granular, and contain a comparatively large nucleus, they probably come from the renal tubules, but their origin in the kidney is not proved unless they are found embedded in casts. Renal cells are abundant in parenchymatous nephritis, especially the acute form. ”

“ Any indication of urinary trouble, and especially with dropsy, weakness, flabbiness and anæmia and a subnormal temperature, should lead to examination of the urine, as a crucial test. A high density is good ground for suspicion. But this is not constant. In advanced cases (chronic interstitial nephritis, small white kidney, atrophic nephritis) it may be 1015 to 1025, in exceptional advanced cases with polyuria, it may be 1010, 1005, or even 1001. With such a condition, however, there is great anæmia, pallor of the mucosæ, and prostration. ”

“ Or the patient may be attacked suddenly as if with acute diffuse nephritis. The urine will contain blood and numerous casts; the dropsy and the other symptoms are rapidly developed. In some of the cases complicated with cardiac disease the history will be that of heart disease rather than that of kidney disease.
When the disease is fairly established the dropsy is always a prominent symptom, often very distressing to the patient. In some patients when once developed it continues to increase steadily up to the time of their death ”

“ Ralfe observes, in his “Kidney Diseases,” that long-standing disease of the genito-urinary passages must be reckoned as among the chief etiological factors of chronic interstitial nephritis (page 227) . The condition of the kidneys in cases of strictures of long standing is known not to be a reliable one, and any incentive to dysuria or to retention, no matter how slight, is apt to lead, eventually—and that even in very young subjects—to that toxic condition mentioned in a former part of this chapter as one of von Jaksch’s subdivisions of toxæmia, the ammoniæmia of Frerichs ”

“ In every patient suffering from chronic diffuse nephritis there are a number of symptoms which seem to depend directly upon other conditions, and not upon the kidney lesions; for if these conditions are removed the symptoms disappear, although the kidney lesions continue. To this category of symptoms seem to belong the headache, delirium, stupor, coma, and convulsions, the nervous dyspnoea, the vomiting in part, the dropsy in part, the diminution of urine in part. ”

“ The possession of typically healthy kidneys is a rare circumstance in this climate. The excessive micturition so universal in infancy, occasioned by excess in diet, is the beginning of renal disease.
Dr. Bright immortalized his name by discovering the fact that, when a man’s last sickness is attended with a certain class of symptoms, as albumen in the urine, final suppression of the urine, and uremic poisoning, they are occasioned by a peculiar disease or degeneration of the kidney. ”

“ Even more important for the sake of the individual himself than for those he is in contact with is the recognition of his pathological condition. Nothing is more likely to cause kidney disease to grow rapidly worse than responsibilities heavier than the individual is accustomed to. When, then, there are symptoms of nephritis it is inadvisable for the patient to be made Superior, and if the symptoms develop after his appointment or election he should be relieved of his responsibilities, at least to a considerable degree. ”

“ Unsuspected cases of nephritis showing only gastric symptoms clinically have been detected by blood chemistry. The significance of albumin in traces and occasional casts in urine has been more definitely established by examination for increase of uric acid in the blood—an increase arguing for an organic lesion. Values of over 4 for creatinine do not occur without great impairment of renal function, and findings of more than 5 have practically uniformly foretold a fatal termination in less than six months, except in acute nephritis and mild bichloride of mercury poisoning. ”

“ Perinephritis and perinephritic cellulitis, i.e., inflammation with or without abscess formation in the connective tissue and adipose layer surrounding the kidney, always occur in cases of suppurative nephritis or pyelo-nephritis. Such inflammations may also, in exceptional cases, follow direct mechanical injury, but they almost invariably represent complications, the organisms infecting the kidney passing through the tissues and the layer of fibrous tissue, or extending by the lymphatic paths, finally attaining the fatty tissue surrounding the kidney and there undergoing multiplication. ”