The Hunterian lectures on the renal function in its relation to surgery : delivered before the Royal College of Surgeons of England / by J.W. Thomson Walker.

  • Sir John Thomson-Walker
Date:
1907
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Licence: In copyright

Credit: The Hunterian lectures on the renal function in its relation to surgery : delivered before the Royal College of Surgeons of England / by J.W. Thomson Walker. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    precaution against surgical shock, there still remained a mortality in the operative surgery of kidney disease against which provision had not been made. This mortality resulted from a failure of the renal function. It is brought about in several ways: the disease may be bilateral and so far advanced that the renal function is only just sufficient for the wants of the individual. An operation of any kind may be sufficient to overbalance the impaired renal function and lead to suppression of urine. The frequency with which this may occur in operations which do not concern the urinary system is difficult to estimate, but it is probably not great, for the presence of advanced renal disease would be looked upon as a sufficient contra-indication to any but operations of urgency. I shall not, therefore, pursue this subject further. When the operation concerns some part of the urinary tract, however, this mortality at once becomes a prominent factor and a consideration of the adequacy or the reverse of the renal function is likely to arise. Thus, in operations upon the lower urinary tract, suppression of urine takes a high place in the mortality figures. Finally, in opera- tions upon the kidney, the question as to the renal efficiency becomes a matter of importance. In my second lecture I shall consider the question of the second kidney in nephrectomy, and it need only be remarked here that such a catastrophe as the removal of a kidney when the second kidney is destroyed by disease, or when only one kidney has developed, demonstrates the need for a complete estimation of the renal function. But apart from the removal of the kidney there are cases of bilateral disease in which a conservative operation upon one organ is sufficient to upset the balance of renal secretion and cause fatal suppression of urine. An attempt to estimate the renal function in these cases has for its object not only the demonstration of a lowered renal function, for that may be already obvious, but the de- cision, if this be possible, as to whether the function is lowered to such a degree that operation will almost certainly prove fatal. I shall therefore consider the subject of the estimation of the renal function, so far as it concerns surgery, under two main divisions: (1) the estimation of the total renal function ; and (2) the estimation of the function of one kidney. 1. The Estimation of the Total Renal Function. Until a comparatively recent date the surgeon has been content to rely upon the symptoms and local signs of renal disease and the examination of the urine in order to judge of the activity or the reverse of the kidneys. I shall not dwell upon these. The kidneys may be exposed by operation and examined with a view to estimate the renal function. Palpation of the kidneys by the abdominal route has fallen into disuse from its unreliability. The exposure and examina-