Nephrite

“ In most diseases the quantity of urinary water is diminished, especially in those in which the activity of the circulation is impaired. There are diseases, however, more especially the granular kidney and certain forms of chronic Bright’s disease, in which the quantity of urinary water is considerably increased, notwithstanding the profound anatomical changes that have occurred in the kidney. There are two forms of suppression of the urine: one is obstructive suppression, seen where the ureter is blocked by stone or other morbid process ”

“ 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. ”

“ When urine contains a larger amount of chemical constituents than it can conveniently hold in solution, a certain quantity crystallizes out, and may be deposited in the kidney or in the bladder. If the crystals run together in the kidney the resulting concretion may either remain in that organ or may find its way into the bladder, where it may remain to form the nucleus of a larger vesical calculus, or, especially in the case of females, it may, while still small, escape from the bladder during micturition. ”

“ It is exceptional for the large branches of the renal artery to be blocked, so that the symptoms produced in the ordinary cases are only the temporary appearance of blood or albumen in the urine. Blocking of the main renal vessels as a result of disease of the walls of the vessels may lead to disorganization of the kidneys. Blocking of the veins, leading to extreme congestion of the kidney, also occurs. ”

“ Serious complications may result from the presence of a stone in the kidney, such as hydronephrosis, from the urinary secretion being pent up behind the obstruction, or complete suppression, which is apparently produced reflexly through the nervous system. ”

“ The hydronephrosis produced by obstruction of the ureter may be intermittent; and when a certain degree of distension is produced, either as a result of the shifting of the calculus or of some other cause, the obstruction is temporarily relieved in a great outflow of urine, and the urinary discharge is re-established. When the hydronephrosis has long existed the kidney is converted into a sac, the remains of the renal tissues being spread out as a thin layer. ”

“ When the kidneys are not working the skin carries off much urea. In fact, a close relationship exists between the kidneys and the skin in the matter of excretion. Thus, with increased perspiration in warm weather comes decreased urine, while in cold weather the blood is sent in and the urine increased in amount.
To incite action of the kidneys drugs known as diuretics may be used. These act in two ways, by stimulating the kidney cells directly and by acting on the general circulation or nervous system. Any emotional or nervous excitement increases the flow of urine. ”

“ In many cases of disease and irritation in the bladder, attended with frequent desire to make water, and pain after its evacuation, also in disorders of the urinary organs, accompanied with the lithic acid, or phosphatic deposit in the urine, I have seen a very liberal internal use of the water decidedly beneficial; and elderly persons, afflicted with organic changes in these organs, have often acknowledged to me that they live in greater comfort, and are freer from irritation or pain, at Malvern than elsewhere. ”

“ Problems to Be Considered.—But in nephritis, there are other problems to consider, which make it impossible to institute such a treatment as will effect a perfect rest of the renal organs. The kidneys represent the chief source whereby the waste products of the body are eliminated. This waste consists not only of the end-products of the nitrogenous foods ingested, but also the end-products of tissue metabolism, which is the inevitable result of the wear and tear of life. ”

“ Renal Calculus.—The urine is usually somewhat concentrated, with high color and strongly acid reaction. Small amounts of albumin and a few casts may be present as a result of kidney irritation. Blood is frequently present, especially in the daytime and after severe exercise. Crystals of the substance composing the calculus—uric [p. 136] acid, calcium oxalate, cystin—may often be found. The presence of a calculus generally produces pyelitis, and variable amounts of pus then appear, the urine remaining acid in reaction. ”

“ The predisposing and occasional causes of urinary suppression, obstruction, and strangury, whether originating in the kidneys, ureters, bladder, or urethra, are inflammation of the kidney or ureter, calculi or sand in the kidneys or ureters; acrid diureticks; spirituous liquors; plethora, spasm, poisons, severe riding, violent heat and muscular exercise; strains of the lumbar and dorsal muscles; long continued posture in a bent position or supine on the back; inactive sedentary life; wounds, contusions, abscess; defecation and crisis of other diseases by the kidneys ”

“ If we are not going to grant the kidneys a faculty for attracting this particular quality, as Hippocrates held, we shall discover no other reason. For, surely everyone sees that either the kidneys must attract the urine, or the veins must propel it—if, that is, it does not move of itself. But if the veins did exert a propulsive action when they contract, they would squeeze out into the kidneys not merely the urine, but along with it the whole of the blood which they contain. ”

“ The amount of urine is generally very much reduced— to a few ounces even. In this patient, therefore, there are the same signs of peripheral neuritis and of dilatation of the heart as in the other case. In addition, there is a some-what firm œdema, which is not altogether cardiac, but, as its character and the circumstances in which it is found suggest, is probably connected partly with lesion of the nerves regulating urinary excretion, and partly with the play of transudation and absorption in the connective tissues. ”

“ It provides points of value in diagnosis, prognosis, and treatment, being especially useful in nephritis, diabetes, acidosis, comatose conditions, gout, and in questions of renal function and treatment, especially dietetic. Urine findings are always dependent upon kidney function, and, by blood chemistry, we can pass behind this barrier. ”

“ It is well known that persons who use the Spa waters, or those of La Madonna, in the territories of Padua, or others of an acidulous or vitriolated nature, or who simply swallow drinks by the gallon, pass all off again within an hour or two by urine. Such a quantity of liquid must take some short time in the concoction: it must pass through the liver; (it is allowed by all that the juices of the food we consume pass twice through this organ in the course of the day;) it must flow through the veins, through the parenchyma of the kidneys, and through the ureters into the bladder. ”

“ In some diseases in which the quantity of urinary water excreted is normal, or even greater than normal, the efficiency of the renal activity is really diminished, inasmuch as the urine contains few solids. ”

“ In chronic nephritis, which may be the result of an acute attack, or as a sequel of other diseases already mentioned, there is seen to be a progressive loss of flesh and strength, marked anemia, gastro-intestinal disturbances, increased blood tension and edema, the latter especially in the face on arising in the morning. Uremia may develop at any time. ”

“ During the period of active congestion the quantity of urine secreted is increased. The scant secretion of urine, dark in color and thick or turbid, is suggestive of an inflammation of the kidneys. The animal moves stiffly, the back may be arched, urination is painful and the urine is passed in very small amounts. The appetite is irregular or suppressed, the pulse strong at first but later small and weak, and the body temperature is elevated. On making a rectal examination we find the bladder empty and the kidneys enlarged and sensitive. ”

“ The kidneys.—The kidneys are close to the backbone, below the heart. They are made of tiny tubes much like the sweat tubes in the skin. The tubes take ashes and other waste matters from the blood, also a great deal of water. They also take away poisons and disease germs when we are sick. The kidneys take away about as much water as the skin, but they get rid of very much more poisons and waste matters than the skin does. If our kidneys should stop their work, we should soon die. ”

“ To those who have received the knowledge of the connections of dropsy, albuminous urine, and disease of the kidney, among the first rudiments of medicine, the facts which establish that connection may appear so simple and easily ascertained, that the amount of labour, the accuracy of the observation and the rigid adherence to the inductive method which characterised the whole of Bright’s researches, may hardly have been suspected, still less adequately appreciated. ”

“ When pure blood is voided suddenly without interruption and without pain, it proceeds from the kidneys; but if the blood be in small quantity, of a dark colour, and emitted with heat and pain about the bottom of the belly, it proceeds from the bladder. When bloody urine is occasioned by a rough stone descending from the kidneys to the bladder, which wounds the ureters, it is attended with a sharp pain in the back, and difficulty of making water. ”

“ Dysury is only a slighter degree of the former: Strangury, a constant irritation to urine, in small quantity, and often with tenesmus.
Inflammation and Calculi of the Kidneys, nephritis, nephralgia: and generally confined to one kidney. The symptoms, shivering,{300} fever, acute pains and heat in the lumbar region, following the tract of the ureters, and various in severity, from calculi excruciating; frequent efforts to micturition; the urine in small quantity, red, bloody, hot, often intermixed with sand, sometimes totally suppressed; with colick, flatulence, bilious vomiting, costiveness. ”

“ It is low in chronic interstitial nephritis, diabetes insipidus, and many functional nervous disorders. It is high in fevers and in parenchymatous forms of nephritis. In any form of nephritis a sudden fall without a corresponding increase in quantity of urine may foretell approaching uremia. It is highest in diabetes mellitus. A high specific gravity when the urine is not highly colored should lead one to suspect this disease. A normal specific gravity does not, however, exclude it. ”

“ On the other hand, we find that suppression of urine with accumulation of urea in the blood may exist for a long time without cerebral symptoms if the suppression is due to obstruction of the ureters; that with chronic congestion of the kidney, puerperal convulsions, and diseased arteries urea is excreted in fair amount, although cerebral symptoms exist; and that even in cases of cerebral symptoms with chronic diffuse nephritis there may be no increase of urea in the blood. ”

“ 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. ”

“ To resume; the patient will content himself, that the only fault in his system is the disordered condition of his urine, and he earnestly seeks for something to touch that particular symptom, forgetting that trifling as he may fancy it, it is not merely owing to the office of the kidneys and bladder, but to the blood itself, whence the urine is formed, and to other circumstances in the economy that influence it. ”

“ Any disorder leading to impaired functional activity of the lungs is causative of an excess of hippuric acid and allied bodies, of oxalic acid, of sugar, etc., in the urine, which irritate the kidneys, even if they do not produce solid deposits in the urinary passages. ”

“ 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. ”

“ On the other hand, the diseases incident to the bladder are various, but principally arise from debility, spasms, and calculous concretions; for an account of which, we refer to the articles Gravel, Stone, and Urine. At present, we shall confine ourselves to the inflammatory state of that vessel, which requires immediate relief. This dangerous malady is occasioned by stimulating medicines; gravel or stones lodged in the orifice of the bladder; violent exercise after a long retention of urine, and especially in hot weather ”