On the waxy or amyloid degeneration of the kidney : a communication read before the Medico-Chirurgical Society of Edinburgh / by T. Grainger Stewart.

  • Thomas Grainger Stewart
Date:
1861
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Licence: Public Domain Mark

Credit: On the waxy or amyloid degeneration of the kidney : a communication read before the Medico-Chirurgical Society of Edinburgh / by T. Grainger Stewart. Source: Wellcome Collection.

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    tubules.1 Of this fact I have never been able quite to satisfy my¬ self, and it does not seem to have been noticed by many observers. Now, as the production of this colour, by iodine and sulphuric acid, is characteristic of a change in the chemical constitution of the parts assuming it, and as it only occurs in certain limited parts of the dis¬ eased structure, it evidently does not constitute the whole morbid change. In almost every case, organs affected with this degenera¬ tion are enlarged and hardened to a degree that cannot be explained by the mere change in the arteries and Malpighian bodies. How, then, is this increase of size and of density to be accounted for % Manifestly, I think, by the infiltration of the whole organ with some dense pale matter, evidently not amyloid in its character, because presenting no special reaction with iodine and sulphuric acid. This fact will be quite apparent to any one who examines the structure microscopically, or even with a lens; for the shining Malpighian bodies are only scattered here and there among the dim, dense, pale tissues of the cortical substance,—and if one brushes a little solution of iodine over the surface, it will at once be seen how small a part of the whole structure is composed of the little red dots and streaks which mark the amyloid degeneration. The further question then arises as to the nature of this matter which constitutes the greater part of the degenerated tissue. I think that it consists of a coagulated exudation, whose transmission through the walls of the vessels has been favoured by their dege¬ nerated condition. This view is supported both by pathological and clinical observation. The convoluted uriniferous tubules are filled with a substance quite distinct from that deposited in the arterial walls and the Malpighian bodies, and closely resembling the exuded matter which we see in other forms of renal disease. If we squeeze out from a waxy kidney the substance filling the tubules, we find it exactly similar to the tubecasts found in the urine during life. These tubecasts first occur in such cases shortly after albuminuria has come on, and they continue to increase in quantity as the case advances. I have never seen any distinct reaction in the tubecasts on the application of iodine and sulphuric acid.2 From these con¬ siderations, we may assume that this matter in the tubes is in reality a coagulated exudation. It may be said that this exudation is simply a result of acute or chronic nephritis supervening upon the amyloid degeneration, be¬ cause we sometimes see kidneys whose vessels have undergone amy¬ loid degeneration without any increase of size. But the fact, that in a large majority of cases the organs are enlarged, taken along with the very gradual progress of the symptoms, seems to me to warrant the rejection of the view. The origin of the exudation 1 Pagenstecher, p. 25 ; also, Foerster's Atlas der MiJcroskopiscTien Patholo- gischen Anatomie, 1859, Plate 36, fig. 2, and letterpress. 2 Dr D. R. Haldane informs me that he has occasionally brought out this re¬ action in the tubecasts.
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