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.

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    disturbance of the balance of the bodily functions. Oohnheim and Leyden make the interesting suggestion that sometimes, per- haps, the immediate cause of nreemic symptoms is the siidden failure of the heart to keep up an active circiilation through the renal vessels; this is quite in accordance with clinical observations of cases of chronic contracted kidney, and it is further supported by the therapeutic results of the employment of cardiac tonics in conjunction with other measures. Still it is difficult to assume sudden cardiac failure for all cases, as, for example, in the acute ursemia of scarlatinal nephritis. In this connection, however, it is interesting to recall the remarks of Sir William Broadbent on the prognostic significance of a pulse of low tension (see p. 335). Diagnosis.—There is no great difficulty in correctly estima- ting the nature of the symptoms of the acute form, and some- times, also, of the chronic forms of uraemia, provided that the existence of kidney disease is recognised, either in consequence of alterations in the urine, or by the consecutive changes in the heart and pulse, or from the presence of general dropsy. The nature of the disease may, however, be more uncertain when, in the absence of any history, a patient is found in a comatose condition. Alteration in the position of the apex beat, accen- tuation of the sounds of the heart, and high tension of the pulse will afford valuable indications, and if urine, withdrawn by the catheter, is found to be albuminous, and to contain casts, there is fair presumption in favour of ureomia. An ammoniacal odour of the breath may occasionally be recognised, but this sign is frequently masked by the odour of alcohol, administered by some well-meaning bystander. In the absence of more cer- tain indications it is, however, injudicious to assign such a case definitely to uraemia. Convulsions and coma are not uncommon amongst patients with nephritis, but they may result from cere- bral lesions, cerebral haemorrhage, or some form of meningitis, causes which are only indirectly connected with changes in the work of the kidney. The difficulties which may sometimes be encountered are well shown by a case mentioned by Fiir- bringer, in which the ]JOst-mortem examination disclosed tuber- cular meningitis together with genuine contracted kidney; as no vascular symptoms had been observed during life, it was