Selected monographs : comprising Albuminuria in health and disease ... Some considerations on the nature and pathology of typhus and typhoid fever ... Moveable kidney in women.

Date:
1884
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Licence: Public Domain Mark

Credit: Selected monographs : comprising Albuminuria in health and disease ... Some considerations on the nature and pathology of typhus and typhoid fever ... Moveable kidney in women. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    59/440 (page 43)
    vascular dilatation as a result, the increase in the secretion of urine is accompanied by appreciable albuminuria.^ Can Ave now draw any conclusions therefrom with regard to the influence of the increased blood-pressure upon the albumi- nuria ? At the first glance, the position of cause and efi^ect seems so clear that this conclusion might be accepted without any hesitation. But there is one important fact of a contrary character, namely, the defective supply of arterial blood while the vessels are constricted. It makes no difference if, as is generally stated with regard to these experiments, the flow of urine altogether ceases during the period of vascular spasm, and the albuminuria consequently afterwards appears Avith the returning secretion of urine, for undoubtedly this phenomenon is to be referred to the previous period, unless haemorrhage sets in. We shall see later on that, when the supply of arterial blood is considerably reduced, but not altogether cut off, the secretion of urine continues, and is accompanied by manifest albuminuria, the causes of which will then be described. The only question at present is to establish the fact that even the diminution of the supply of blood, which occurs in the first period, explains per se the albuminuria, and that, consequently, these experiments are of no force at all as arguments in favour of the influence of increase of the arterial pressure. These experiments would have far greater demonstrative force, for or against the existence of this influence, were it possible so to perform them that this effect of pressure, and nothing else, came out as the resultant. The idea formerly was that the pressure in the aorta and other * Litten (46), who has performed the above-mentioned experiments with the same result, especially with regard to the albuminuria, and was disposed to consider this latter as caused by the increase of the arterial pressure, explains this now as the consequence of the dilatation of the vessels and of the resulting retardation of the current of blood, and he finds in this a positive confirmation of Runeberg’s views, which he had regarded as correct (seepp. 2 and 31). But inasmuch as the condition in question is that of an active dilatation, as a matter of course there can he no retardation of the current of blood, a fact which is also incidentally revealed by the increase in the quantity of urine. It is evident that other conditions prevail when the pressure is raised in consequence of impeded escape from the veins and passive vascular dilatation.