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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    into long, spindle-shaped bodies. The blood changes I have ob¬ served only when the degeneration affected the lymphatic or blood glands. The patient may continue in this state for months, or even years—may, indeed, undergo a temporary improvement—the liver and spleen becoming diminished in bulk, and the blood resuming a more healthy character; but, sooner or later, for the most part ascites and general dropsy gradually supervene, accompanied fre¬ quently by diarrhoea, which is at times found quite uncontrollable. The urine, now very albuminous, diminishes in quantity, so as at times to be almost or altogether suppressed ; effusions into the serous cavities, or severe bronchitis, ensue ; the patient becomes exhausted, and sinks; or drowsiness comes on, and the disease terminates fatally, amid coma and convulsions. Let us now examine some of these symptoms more in detail. 1. The Amount of Urine.—It has been remarked that increased amount of this secretion is one of the earliest symptoms of the amy¬ loid degeneration. In describing the minute pathological anatomy of the kidneys in this disease, I stated that H. Meckel showed that the degeneration occurs first in the small, non-voluntary muscular fibres which surround the smaller arteries. The function of these muscular bands is to regulate the supply of blood to a part; and if their structure be degenerated, it is evident that this regulating power must be lost, and the vessels and the capillaries beyond them become dilated. In this state, transudation of the watery part of the blood must take place more freely than usual, and consequently the urine would be increased in quantity. Now this is exactly what we find in the first stage of the waxy degeneration. That this increase of urine is not merely a result of the increased thirst which accom¬ panies it, is shown by the fact, of which I have repeatedly satisfied myself, that the amount of urine passed was greater than the ascer¬ tainable fluids consumed during 24 hours. The urine is also of low specific gravity—1005 to 1015. This does not seem to depend upon a diminution of the actual amount of solids excreted, but merely upon the extreme dilution of these solids in the greatly-increased fluid. Of course, the amount of urine is affected to a considerable degree by diarrhoea or other complications. Thus, in a case which Dr Todd records,1 the amount of urine never rose higher than 4 pints, and averaged about 2, apparently because the patient suffered from constant diarrhoea. But towards the termination of the disease the urine becomes diminished in quantity, while the albumen and tub'ecasts relatively increase. This is evidently caused by the blocking-up of the tubuli uriniferi, so as to prevent the passage outwards of the fluid secreted; and also may in part be accounted for by the great diminution which ultimately takes place in the calibre of the affected arteries. That in the early stage of waxy or amyloid degeneration the urine 1 TodcVs Clinical Lectures on Urinary Diseases, p. 93.
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