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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$particularly in large numbers, is against a renal albuminuria; since, as the writer has shown, the sediment in simple uncomplicated nephritis, while it contains some leukocytes of a diflPerent variety, is devoid of true pus corpuscles, or contains only a negligibly small number of these elements.^ A combination of true and false albuminuria—as, for example, when nephritis and cystitis are both present—is recognized, as will appear from what has been said, by the fact that the filtered urine contains a large quantity of albumin. When, however, the renal affec- tion is attended by only slight albuminuria—as, for example, in certain ca^es of contracted kidney—its recognition when associated with some other disease, such as a cystitis, may present greater difficulties. But in such cases symptoms referable to other organs, the heart and blood- vessels or the retina, and other properties of the urine, such as increased quantity with lowered specific gravity and the presence of casts, will point to the presence of a kidney lesion. It will rarely be necessary for diagnostic purposes to resort to a method proposed by Thompson, which consists in thoroughly flushing out the bladder and collecting the urine from the kidneys, by means of the catheter, before it becomes mingled with the contents of the bladder. [In certain cases, however, ureteral catheterization might be of great help in showing whether the urine from the kidneys is free or not from pus and albumin.—Ed.] In time or renal albuminuria, with which we are exclusively concerned in the present work, the albumin excreted in the urine is in the large majority of cases coagulable by heat, and cannot be distinguished from the albumin contained in blood-serum, serum-albumin (serin^, serum- globulin (pat'aglobulin), and nueleo-albumin. The first usually pre- dominates over the other two. In very rare cases only one of these three albuminous, substances has been found in the urine, and such cases are therefore designated as simple serinuria, globulinuria, and nuoleo-albuminuria respectively.^ The relation between the two substances in ordinary cases of albu- minuria, which is designated by F. A. Hoffmann as the albumin quotient (serin-globulin), is extremely variable, and frequently differs not only from the quotient of normal blood-serum, which is 1.5—2, but also from the quotient of serum in disease and of the blood-serum of the same individual from whom the urine is obtained. There is nothing ^ Senator, in Virchow's Archiv, cxxxi., 1893, p. 385. See also Reinecke, loc. cit., and Diss, inaug., Jena, 1894. ^ Serinuria was observed by F. A. Hoffmann in the case of a woman suflering from cancer of the stomach {Virchow's Archiv, vol. Ixxxix., p. 271); by Pichler and Vogt after compression of the extremities {Centralbl. f. inn. Med., 1894, No. 17) ; by F. D. Boyd {Report of the Royal College of Physicians, Edinburgh, 1894), in four cases of subacute and chronic nephritis, on occasional days; and by J. Sti-auss (Diss, inaug., Strass- burg, 1895). Globulinuria was observed by Werner {Deutsch. med. Woch., 1893, No. 46) in a case of acute nephritis ; by Maguire {Lancet, 1886, p. 1082) in the case of a puerpei-al woman; and by M. Matthes in the case of a leukemic woman {Berlin, klin. Woch., 1894, No. 24). Simple nucleo-albuminuria was observed by J. Strauss {loc. cit.) in chronic interstitial nephritis and in urine from a congested kidney in a case of emphysema. According to Estelle and Faveret {Revue des sciences med., 1882, No. 11), serinuria or globulinuria can be pi'oduced experimentally by injecting serin or globulin. The state- ments of earlier authors are untrustworthy, because they probably confounded globulin with nueleo-albumin.$