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
Catalogue details

Licence: Public Domain Mark

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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    and will often be found when the symptoms are quite insignificant. The only feature that may be occasionally absent from the complete picture is albuminuria. Now, when all the other symptoms are present, the diagnosis of contracted kidney may be made with a high degree of probability even in the absence of albuminuria, especially when there is albuminuric retinitis or gallop rhythm without cardiac lesion, or when after repeated examination it can be positively demonstrated that certain substances, such as methyleue-blue, iodin, and sugar after the adminis- tration of phloridzin, are eliminated too slowly in the urine; but to remove every possible doubt, it is always desirable to demonstrate the presence of albumin, and the attempt will rarely prove unsuccessful if the urine is examined repeatedly, especially if the precaution is observed —which unfortunately is often neglected—of examining the urine obtained at various times during the day and not alone the night urine, and in doubtful cases the urine passed after active exercise and a copious meal (see p. 33). The differential diagnosis from other conditions associated with poly- uria is usually quite easy when contracted kidney is fully developed. From diabetes mellitus and diabetes iiisipidus it is distinguished by the absence of cardiac hypertrophy, which does not occur in these two con- ditions [or rarely—Ed.] ; from the former also by the lower specific gravity and absence of sugar from the urine, and the latter by the presence of albumin. The specific gravity of the urine does not often fall so low in contracted kidney as in diabetes insipidus. A combination of diabetes mellitus with contracted kidney (see p. 263) may be suspected when albumin is found in addition to sugar for a pro- tracted period without any, or with only very few, morphologic constitu- ents, and the diagnosis becomes assured if there is hypertrophy of the left side or of both sides of the heart, not due to a valvular lesion. It should be mentioned again, however, that the excretion of sugar in the urine often ceases when nephritis develops. The combination of diabetes insipidus and contracted kidney cannot be recognized with certainty unless the presence of diabetes alone had already been demonstrated; but such a combination may be suspected in cases in which there is cardiac hypertrophy and the patient com- plains of severe thirst and voids excessive quantities of very watery albuminous urine of a specific gravity of less than 1005. Pyelitis might, on account of the polyuria which is frequently present, and the albumin in the urine, arouse the suspicion of indurative neph- ritis, but an examination of the urinary sediment and due consideration of the conditions of the circulatory apparatus, etc., will suffice to guard against error. The assumption of renal sclerosis on an arteriosclerotic base^?*. e., primary sclerosis of the kidneys—is justifiable when the signs of arterio- sclerosis have been present before the symptoms pointing to disease of the kidneys, such as polyuria and albuminuria, are observed, when marked hypertrophy with dilatation of the heart, and cardiac asthma set in early, and when there exist causes which are especially favorable
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