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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    surface. They may be rendered more readily visible by being stained with weak iodin solution or some other stain. Hyaline casts take the same stains as coagulated albumin ; thus, for example, they are stained violet by Ehrlich's triacid mixture ; and in other respects they also give the reactions of albumin. [It is often better to begin the search for casts with a drop of urine on the slide without a cover-glass and using a low power. In this way a much larger and thicker field can be seen, a great advantage where the casts are scattered. Care is necessary, also, not to use too strong a light, as the delicate, transparent hyaline casts may otherwise readily escape detection.—Ed.] There has been much dispute about the nature and origin of these casts. The oldest view, to which reference has been made on page 44, is that they consist of coagulated fibrin derived from an exudate, such as is found in inflammation elsewhere in the body. Not to mention other objections, this view is refuted by the fact that hyaline casts unquestionably occur in conditions in which there is not the faintest sign of inflammation, as in congestion of the kidneys, in simple amyloid degeneration, in the above-mentioned cases of so-called dyscrasic albu- minuria in which no abnormality of any kind can be demonstrated in the kidneys (p. 38), and finally in the albuminuria of the newborn (see p. 37). Then again, as Rovida ^ demonstrated long ago, these casts do not give the same chemical reactions as true fibrin. It is true that, in spite of this discovery of Rovida's, it was argued later, from the fact that many of these casts present a striated or fibrillar appearance like that of true fibrin, and that many of them take the so-called Weigert's fibrin stain (a blue color when treated with anilin water, gentian-violet, and iodin), that they in fact consist of exuded and coagulated fibrin. But in the first place the stain referred to is not by any means specific for fibrin, for O. Lubarsch ^ has shown that the stain is equally characteristic of other fibrillar and hyaline substances that have nothing to do with fibrin ; and, conversely, hyaline casts behave differently in the presence of other fibrin stains, such as those of Altman and Russell; and finally it has been discovered by Th. Burmeister^ that the true products of exudation and transudation, which are found coagulated in the capsules of the glomeruli and in the uriniferous tubule after temporary compres- sion of the renal veins, do not stain by Weigert's method. This leaves only two possible sources for the albuminous substance of hyaline casts—namely, the albumin of the blood-serum and the epi- thelial cells of the uriniferous tubules. As regards the former, the widespread impression that the albumin which escapes from the vascular system at once undergoes coagulation in the capsules of the glomeruli or in the uriniferous tubules, and so leads to the production of casts, is absolutely mistaken, as the writer ^ Rovida in Moleschotfs Untersuchungen zur Naturlehre, etc., 1872, xi., p. 1. ^ Centrcdbl. f. allg. Pathologie and path. Anut., 1893, iv. ^ Virchow's Archiv, cxxxvii., 1894, p. 442.
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