Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

94/440 (page 78)

IV.—Albdmindeia as Dependent Upon Degeneration of the Eenal Epithelium. Of the tissue-elements, other than those of the vascular system, which compose the renal parenchyma, the epithelium alone remains for consideration in our study of albuminuria. The most important are the epithelial cells of the uriniferous tubules, next come those of vascular tufts, and in the third place, though these are not so directly concerned, the epi- thelial cells which line the internal surface of the Bowman- Miiller's capsules. In former times the epithelial cells were credited with the possession of a considerable amount of influence in the causation of albuminuria, but this was attributed only to those of the first class, the existence of the others not being recognised. Two principal ideas prevailed on this subject. It was supposed that in morbid states of the epithelium, the albumen which normally transuded through the glomerular vessels, to be taken up and assimi- lated by the epithelium, no longer underwent this process, but escaped by the urinary tubules ; 'or, secondly, that the albumen passed into these channels from the blood-vessels by which they are surrounded, because the epithelial cells having undergone nutritive derangement, were unable to discharge their normal function of preventing such escape from taking place. Modern theories pay little attention to this question, but they usually cut the matter short by asserting that in fatty or other degeneration of the epithe- lium, as in phosphorus-poisoning, in severe anemia, and severe febrile infectious diseases, no albumen is found in the urine, and therefore the epithelium can have no share in the production of albuminuria. And yet these very theories are based upon the doctrine that the epithelium prevents the escape of albumen from the blood, and that normal urine is therefore free from this constituent. The contradiction stares us in the face ! At all events those who assume that the albumen is retained in the blood by the agency of the epithelial investment of the glomerular vessels, must allow the possibility of albuminuria being caused by derangement of