Albuminuria and Bright's disease.

  • Tirard, Nestor Isidore Charles, Sir, 1853-
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: Albuminuria and Bright's disease. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    341/422 (page 293)
    hypertrophied, while the inner coat indicates the presence of endarteritis obliterans. The changes in the tubules are by no means constant in their nature: sometimes the epithelium in the convoluted tubules may show signs of proliferation, and the lumen of the tubule may be filled with white corpuscles. Similar collections of leucocytes may be found in the straight tubules, and these occasionally lead to detachment of the epithelial cells. Frequently, the whole of the kidney is hypersemic, and the distinction between the cortex and the medulla is obscured. As the abscesses enlarge great destruction of renal tissue may occur; adjacent purulent collections appear sometimes to have fused, sometimes the suppuration is so great that very little true renal tissue can be found. The purulent collection may even extend to adjacent organs, and may lead to the formation of peri-nephritic abscesses, or indeed of fistulse, which may point in the lumbar region or in the front of the abdomen. Cases have often been mentioned of extension to the liver, or of perforation of the colon, the small intestine, or even of the lung. Reference has already been made to the lardaceous changes which afiect the blood vessels; Fiirbringer states that he has seen bilateral lardaceous degeneration, even when sup- purative nephritis had only attacked one side. 8ijm]jtoms^ course^ and diagnosis.—So far as these cases come under medical observation, it must be admitted that while the development of numerous minute abscesses may be sometimes suspected, it is frequently extremely difficult, if not impossible, to be certain of their existence. In pyjemic cases, or in ulcera- tive endocarditis, the formation of minute abscesses may be sometimes suggested by indefinite symptoms pointing to renal trouble; far more commonly these minute purulent collections are found as revelations of the post-mortem examination. The pyaemic abscesses are mostly of greater size, but, unless they cause alteration in the nature of the urine, their presence may be unsuspected. They appear to form fairly rapidly, without definite local symptoms; very often, even when symptoms are present, they may be obscured by the primary affection, or may be attributed to the primary affection rather than to any change in the structure of the kidney. The points to which attention should be directed are those