Diseases of the kidneys and of the spleen : hemorrhagic diseases / by Dr. H. Senator and Dr. M. Litten ; edited with additions by James B. Herrick ; authorized translation from the German, under the editorial supervision 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 Dr. H. Senator and Dr. M. Litten ; edited with additions by James B. Herrick ; authorized translation from the German, under the editorial supervision of Alfred Stengel. Source: Wellcome Collection.

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    and allowed to stand for twenty-four hours. The height of the precipitate (albu¬ min) depends, among other conditions, on the external temperature; hence, in order to obtain comparable readings, the temperature should be as uniform as possible. Highly concentrated urine should first be diluted, as uric acid and coloring-matter will be precipitated in addition to the albumin if this precaution is neglected. As the scale of this albuminimeter is not carried beyond 7 parts in 1000, the urine must be diluted with a definite quantity of water if the proportion of albu¬ min exceeds that amount, when the proportion of albumin for the original urine can be calculated. The following procedure, recommended by Th. Lohn- stein,1 has the advantage of being more accurate, and it is at the same time com¬ paratively simple. The specific gravity of the urine is determined to 5 decimals by means of a special areometer devised by the originator of the method; the albumin is then removed by boiling if necessary, the addition of a little acetic acid, and after enough water has been added to the filtrate to restore the original volume, the specific gravity is taken again. The difference between the two readings multiplied by 720 gives the proportion of albumin contained in the specimen. [In practice, besides the Esbach method and the rough estimate made by noting the height of the column of albumin that forms after precipitation and standing for several hours, there may be mentioned the estimation made by noting the thickness, density, and quickness of formation of the albumin ring at the point of contact of the urine and nitric acid. This is, of course, only an approx¬ imate estimate, and is of value only after one has had experience. In attempting a quantitative estimate by this method, the same reagent glass, preferably a coni¬ cal sediment glass, should always be employed, the same amount of urine and acid, and the same conditions, so far as possible, as to light. It is remarkable how one, by training, can in this way approximate the amount of albumin in a specimen of urine. Also by the use of the centrifuge, employing graduated tubes, such as the Purdy tubes, and previously diluting when the percentage of albumin is seen to be high, a quite accurate and rapid quantitative examination can be made. Much confusion often arises, at least in the United States, because some phy¬ sicians make these approximate quantitative examinations in one way, others in another, and because percentages are sometimes stated according to the weight standard and again according to that of volume. It should always be made clear when reference is made to a volume percentage. Thus, a statement that there is 3 per cent, albumin in a urine would mean an exceedingly large amount if a weight percentage is meant; a much smaller amount if a percentage by volume is implied.—Ed.] The quantity of albumin excreted in the urine usually varies from a mere trace to several grams in a thousand. An albuminuria of more than 10 parts in 1000 is rare ; in exceptional cases larger quantities (6 to 8 per cent.) have been observed. The writer made such an observa¬ tion for several consecutive days in a case of subacute nephritis. Physiologic Albuminuria.—For a long time the doctrine pre¬ vailed that normal urine is absolutely free from albumin, so that the most minute excretion of albumin was regarded as pathologic and as a sign of “ Bright’s disease of the kidneys.” Later, however, when analyses were made with greater frequency and more delicate methods were employed, albumin was found in cases in which no renal affection, or even any other disease, could be demonstrated ; and this excretion of albumin was therefore regarded as a purely functional disturbance. This discovery cast a shadow of doubt on the importance of albuminuria as a symptom of disease, especially as albumin continued to be found with ever-increasing frequency in normal urine obtained from healthy individuals as the tests employed increased in delicacy and sensitive- 1 PfluyeAs Archiv, lix. and lx.
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