Remarks on orthostatic albuminuria / by F. Parkes Weber.

  • Frederick Parkes Weber
Date:
1911
Catalogue details

Licence: In copyright

Credit: Remarks on orthostatic albuminuria / by F. Parkes Weber. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    4/9 (page 2)
    would be free from albumin, or a sample of the urine passed at ten or eleven o’clock, precisely that most likely to contain the greatest amount of albumin. Though in cases of orthostatic albuminuria the time of day some- times makes a considerable difference in the amount of albumin in the urine, even when the patient remains up and about during the whole of the day, it has been experimentally proved (in some cases, at all events) that the posture, not the time of day or the time of meals, is the chief determining cause in the production of the albuminuria in question. (There must, of course, be some other cause, but to this I shall refer later.) For instance, if a patient with orthostatic albuminuria remains lying in the recumbent position in bed throughout the day, no albumin appears in his urine, and thus it is that in hospital in-patients the presence of orthostatic albuminuria is frequently overlooked, the specimens of urine for examination being generally passed whilst the patient is, or has just been, lying in bed. In orthostatic albuminuria the albuminous urine often contains calcium oxalate crystals, and occasionally a few red blood-corpuscles are found. The presence of these red cells may turn out to be a (temporary) genuine feature of orthostatic albuminuria, but it may on the other hand be merely connected with concomitant oxaluria. Usually tube-casts are absent, but, by the help of the centrifugal machine, a few hyaline casts and even one or two granular or cellular casts may be detected. Perhaps, however, in these cases it would be more accurate to speak of “ hyaline casts containing cells or granules ” than to call them typical “cellular” and “granular” casts. The administration as a “test ” of calcium lactate (suggested by Sir A. E. Wright) seldom suffices, even for a few days, to remove the albumin from the urine of patients with typical orthostatic albuminuria. • This type of albuminuria occurs of course in girls as well as in boys, and possibly routine examination of the urine of children will show that its average commencement is at a slightly earlier age in girls than in boys. I believe that amongst cases of albuminuria in apparently healthy children and young adults orthostatic albuminuria is by far the most frequent type, and I do not think that albuminuria in these apparently healthy subjects should ever be regarded as belonging to any other than the orthostatic class unless it can be definitely ascertained that specimens of the urine passed immediately on getting out of bed after the night's rest contain albumin. O