Diseases of the kidneys and of the spleen : hemorrhagic diseases / by Dr. H. Senator and Dr. M. Litten ; edited with additions by James B. Herrick ; authorized translation from the German, under the editorial supervision of Alfred Stengel.

  • Senator, H. (Hermann), 1834-1911.
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the kidneys and of the spleen : hemorrhagic diseases / by Dr. H. Senator and Dr. M. Litten ; edited with additions by James B. Herrick ; authorized translation from the German, under the editorial supervision of Alfred Stengel. Source: Wellcome Collection.

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    ever occurs as a clinical manifestation in the hitherto accepted sense of the term. All that we know positively is that there are certain forms of albuminuria in which the condition of the blood is either probably or undoubtedly altered, and yet the changes observed either clinically or anatomically in the kidneys in albuminuria of undoubted renal origin are not demonstrable. It must not be inferred, however, that no change of any kind is found in the kidneys; for, as a matter of fact, changes in the epithelium of the uriniferous tubules can quite often be demon¬ strated in the cases of albuminuria at present under consideration, but these changes have only recently been recognized, and they were for¬ merly not thought to have any connection with the albuminuria, because it was customary to assume that the glomeruli were the source from which the albumin was derived in every case of albuminuria—an assumption which, as the writer has already explained on page 35, does not appear to be justifiable. In this category belong the following forms of albuminuria : 1. Febrile albuminuria. This term has been applied since Ger¬ hard t’s 1 time to the excretion of albumin which occurs in the acute infectious diseases, typhoid fever, pneumonia, rheumatism, the acute exanthemata, diphtheria, influenza, and erysipelas during the fever and disappears with it. In addition to albumin, the urine often contains hyaline casts and albumoses (propeptone), sometimes these latter with¬ out albumin, but never any other (morphologic) constituents indicative of true inflammatory renal disease. It is in these very cases that the above-mentioned parenchymatous—that is, epithelial—changes have been found in very recent times, and were by many regarded as the first beginnings of an acute inflammatory process, caused by infection and intoxication. (See Acute Nephritis.) Febrile albuminuria may there¬ fore be regarded as the expression of a very mild grade of infectious nephritis (Leyden 2) ; but it is somewhat remarkable that the nephritis as well as its product albuminuria should disappear with the fall in the temperature. The febrile process, however, is attended by a number of other factors capable in themselves, and cl fortiori when they act together, of producing albuminuria. These factors are changes in the constitu¬ tion of the blood ; such, for example, as an increase in the proportion of urea, and possibly also in that of the salts and the albumin, the presence of microbic toxins, or perhaps of albuminous bodies altered in such a way as to be more readily dialysable (albumoses, see reference to Krehl and Matthes on p. 24); changes in the blood-pressure, especially ischemia in the kidneys; the elevated temperature; and finally the concentration of the urine. 2. Albuminuria occurring in non-febrile general diseases with special involvement of the blood and without demonstrable changes in the kidneys. This category includes the cases of albuminuria which occur quite fre¬ quently in the various forms of benign and malignant anemia, in leu¬ kemia and pseudoleukemia, scorbutus, and in many cases of icterus, 1 Deutsch. Arch. f. klin. Med., v., 1868, p. 212. 2 Zeitsc.f. klin. Med., iii., 1881, p. 161.