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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    sion that the kidneys in such cases were entirely normal and that there was no altemtion in their function. [It must be remembered, however, that with the use of the cen- trifuge, and particularly when the lower portion of urine that has stood for twelve or twenty-four hours in a conical sediment glass is cen- trifuged—i. e., with a refinement of centrifuging and of sedimentation —an occasional cast may be found in the urine of nearly every indi- vidual, even of young adults and those in seemingly good health/ And in those past the middle period of life too harsh an interpretation ought not to be put upon the detection of an occasional cast. This fact is of great importance in examinations for life insurance. It is doubtful if in many of these cases the stray cast means much more as regards health than the appearance of wrinkles on the face or a few gray hairs on the head as one advances in years.—Ed.] The number of casts in the urine is subject to great variation. They are found in greatest abundance in acute inflammation of the kidney and in chronic, so-called parenchymatous nephritis; they are less numerous in the contracted kidney and in amyloid degeneration and congestion of the kidneys, in which cases they are at times only found after a long search in the sediment obtained by centrifugatiou. They vary also as to length and, in a lesser degree, as to thickness. Not in- frequently we find very short fragments which cannot be identified as casts except by comparison with other larger ones; in other cases casts may attain an unusual length, 1 mm. and more, the amorphous hyaline casts being the ones which almost exclusively attain such an unusual length. Their thickness corresponds approximately to the lumen of the uriniferous tubules at different points or to the lumen of abnormally distended sections of these tubes. Individual casts are often spiral in form, either throughout their entire extent or only at one extremity; but this spiral shape is not a proof that the casts are derived from the tortuous portions of the uriniferous tubules; it may be due simply to the progress of the tough, elastic mass of which the cast is composed through a narrow canal (P. K. PeP), or to its being forced from a narrow canal into one with a larger caliber (H. Senator^). Casts with forked or bifid extremities are extremely rare. Casts are divided, according to their outward appearance, into (1) such as are composed wholly or chiefly of cells ; (2) granular casts ; and (3) amorphous casts presenting a more or less uniform, homogeneous appearance without any distinct structure, or at most a striated surface. In addition to these three varieties there are all kinds of transitional forms, including those in which one part of a cast belongs to one variety, and the remainder to one of the other two varieties. The casts are also very frequently covered with all kinds of urinary constituents, such as cells, crystals, microparasites, and the like. Sehrwald * has dem- ' Cf. Haines and Skinner, An Improved Method of Detecting Casts in the Urine, Jour. Am. Med. Afsoc, xxx., No. 5. 2 Zeits. f. klin. Med., ix., pp. 36 and 37. '^ Deutseh. Arch. f. klin. Med., li.,pp. 413 and 621. *Deutsch. med. WocL, 1890, No, 24.
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