Volume 2

Clinical diagnosis : case examination and the analysis of symptoms / by Alfred Martinet.

  • Martinet, Alfred, 1868-1922.
Date:
1922
Catalogue details

Licence: In copyright

Credit: Clinical diagnosis : case examination and the analysis of symptoms / by Alfred Martinet. Source: Wellcome Collection.

    24/772 (page 652)
    In the majority o£ cases, anuria remains complete in spite of all attempts at treatment and the patient dies in coma five to ten days after the beginning of symptoms, generally without having shown edema or convulsive manifestations. Thus, anuria, coma, and death may be said to summarize the clinical picture, the entire illness being gone through without the patient developing any edema or signs of advanced uremia. The ratio of blood urea may rise very high. In one such case the author found 5.60 grams of urea per liter. This applies not only to the hyperacute nephritis following acute intoxication in a previously healthy person, but likewise in the much more uncommon cases of hyperacute nephritis appearing during the fastigium in acute diseases such as typhoid fever, scarlet fevèr, pneumonia, etc. Recovery is altogether exceptional. Passing mention may be made of the marked therapeutic utility of isotonic or hyper¬ tonic glucose or lactose solution in these cases. (d) Acute exacerbations in chronic nephritis.—“These might, by the uninitiated, be mistaken for acute nephritis. The prog¬ nosis in these cases is that of the form of chronic nephritis upon which the acute congestive exacerbation has been superim¬ posed.” (Castaigne). CHRONIC FORMS OF ALBUMINURIA. “The étiologie circumstances under which chronic albumin¬ uria may be encountered are complex and should be divided into several main classes, which the physician may call to mind when confronted with a case of chronic albuminuria, viz., 1. Chronic nephritis. 2. Chronic infections. 3. Chronic toxic and autotoxic states. 4. Circulatory disturbances(Castaigne). I. Albuminuria of chronic nephritis.—Albuminuria having been found to exist, it is necessary to know what variety of chronic nephritis is present and to what extent the renal func¬ tions are impaired. A systematic investigation should, there¬ fore, be made of : (a) The elimination of chlorides, by examining for edema and, if need be, estimation of the chloride balance.