Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel.

Hermann Senator

Date:: 1905

Credit: Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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$our knowledge, be attributed with certainty to disease of any other organ, and are therefore regarded rather as independent forms of disease. The affections referred to are hemoglobinuria, lipuria and chyluria, oxal- uria and phosphaturia. ALBUMINURIA AND ALBUMOSURIA. Albuminuria—that is, the occurrence in the urine of albumin in solution—may be due to the admixture of albumin or albuminous fluids, such as blood, pus, spermatic fluid or tumor juices, with the urine that was free from albumin as it came from the kidneys; or by the entrance of albumin into the urine within the uropoietic portions of the kidney, the glomeruli and uriniferous tubules, so that the urine already contains albumin when it escapes from the kidneys into the passages leading from the kidney. In the former case we speak of spurious or false albumin- uria {cilbuminuria spuria, pseudo-albuminuria), while the second variety is designated true or genuine albuminuria (albuminuria vera, renalis) or simply albuminuria. [The first variety might also be termed infra- renal, as the albumin enters the urine below the kidney proper.—Ed.] The distinction between spurious and true albuminuria usually presents no difficulties; for fluids that enter the urine after it has left the tubules of the kidney, in addition to containing a variable quantity of cellular elements, usually settle at the bottom of the vessel on standing or on centrifugalizing, and the supernatant layer of urine, which is clear or can be rendered so by filtering, is either free from albumin or contains only a minute quantity, out of all proportion to the number of cellular elements found in the sediment. According to Goldberg,^ when the admixture consists only of pus, and the albumin present is mechanically mixed with the urine—in other words, when there is spurious albuminuria—the relation between the quantity of albumin, as determined with Esbach's albuminometer, and the number of pus corpuscles contained in 1 c.mm., as counted with the apparatus of Thoma-Zeiss, is less than about 1 : 50,000—that is to say, if there are 50,000 pus corpuscles in a cubic millimeter of the sediment, and the albumin contained in the clear fluid above is more than 1 part in 1000, the albuminuria is not due solely to the admixture of pus. (See also Hematuria.) This method is, of course, not exact, since the counting of the pus corpuscles itself is subject to inaccuracies and the pus cannot be uniformly distributed in the urine, and, finally, Esbach's albuminometer gives only an approximately accurate result; but in favorable cases the method is of some value in deciding whether the albuminuria is genuine or spurious.^ The kind of albuminuria present can also be determined by examin- ing the sediment microscopically for the presence of cells and other tissue elements that do not belong to the kidney. It is to be remembered that the occurrence of true pus corpuscles (multinuclear leukocytes), 1 Centralbl. f. die med. Wissenschaften, 1893, No. 36. 2 S. K. Keinecke, Berlin, klin. WocL, 1895, No. 49.$