Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

48/440 (page 32)

pressin-e inside and outside the blood-vessels, and consequently -the filtration-pressure, become diminished. This pheno- menon, which he regards as supporting his view, has been simply explained by F. Hoppe (Seyler) as exemplifying the generally received view concerning the influence of pressure, that is to say, that with increasing pressure more water is absorbed, the fluid becomes concentrated, and as a matter of course the quantity of albumen is thereby increased (39). Notwithstanding the above objections, there is a sense in which we can accept Runeberg's assertion that albuminuria is caused by diminution of the blood-pressure in the kidney, but we do not agree with him in supposing that the altered circumstances permit albumen to escape in places where hitherto no such passage had occurred, the true explanation being that relatively less water escapes, the quantity of albumen is therefore increased, and the albuminous transu- dation is rendered more distinct—it becomes, that is, an .appreciable phenomenon. The diminution of pressure therefore facilitates the discovery of the escape of albumen. In addition to this, the diminished pressure favours the appearance of albumen by reason of the influence it exerts upon the second factor concerned in the formation of urine, viz. the secretion of the epithelium of the uriniferous tubules, ,a factor altogether neglected by Runeberg, and all others who have endeavoured to explain the phenomena of albu- minuria. We shall explain at length in a subsequent page .how albuminuria occurs through the collective efi^ects on both factors, of a reduction in blood-pressure when this is present (S. III). Our principal task now is to show how it is that under normal conditions albuminuria, i.e. the manifest presence of albumen in the urine, is not an ordinary occurrence, and with regard to this, the second factor, the secretion of the true glandular epithelium, is of considerable importance. This secretion, containing the so-called specific consti- tuents of the urine, dissolved in water, and free from albu- jnen—a fact requiring no demonstration with such views .as are now prevalent—passes into the tubuli uriuiferi and jnixes with that transudation from the glomerular vessels, which, as wo have seen, is extremely poor in albumen. It