ACCIDENTAL ALBUMINURIA.
It has long been accepted that the mere presence of albumin in the urine in small quantities does not necessarily indicate the presence of organic disease of the kidneys. When traces of albumin are present and no organic disease of the kidney can be discovered, the symptom is termed functional albuminuria. This subject still re quires elucidation, although the literature is copious and recent. Senator, Leube, Posner, and others hold that traces of albumin may be found in the urine of healthy people (physiological albuminuria).
Many of the observations recorded, however, lack the imprint of accurate research for determining the presence of serum al bumin as distinct from that which is said to characterize cardiac and amyloid kidney (Sernmola), osteomalacia, and other diseases. There is no doubt, however, that some of the cases which are con sidered to be albuminuric are examples of mistaken diagnosis, due to inaccurate examination. Thus Malfatti " mistook mucin for serum albumin. In some, traces of blood or pus have been overlooked, in others an obstruction to the free outlet of urine from the ureter or bladder has remained undiscovered, and the albumin detected in the urine is serum due to strangury or spasm. Lastly some of the young men, in whom a diagnosis of albuminuria is made, are passing seminal or prostatic fluid in their urine, and in such cases it is well known that a trace of albumin may be found. In this article we shall treat of those cases in which albumin emanating from an extra renal source becomes mixed with the urine, a condition known as accidental albuminuria.
Extra-Renal Albuminuria, or accidental albuminuria, is due to the presence of (a) pus, (b) blood, (0 serum, (d) chyle, (e) semen.
a. Pus. —The urine of gouty people not infrequently contains a slight admixture of pus arising from a mild catarrh due to the irrita tion, direct or indirect, of uric acid. The pus may cone from any part of the collecting or conducting passages, and no symptoms are present to mark its origin or cause. Dietetic irregularities or exposure to cold, in feeble and delicate persons, especially in the middle-aged and elderly, says Italie, will often induce a catarrh of the mucous membrane, of sufficient intensity to lead to the formation of pus corpuscles. Virchow has recently related how in his own case,
during an attack of gout, his urine became albuminous and on exami nation was found to contain pus, with an abundant deposit of uric acid crystals." Perhaps, however, the larger number of mistakes are made in deal ing with patients who are suffering from a symptomless deep gleet and its effects.
The following is an excellent example: An officer of the English army was offered an important African governorship, but found himself debarred from accepting it by a medical report that he was suffering from albuminuria. He had seen active and arduous service in Afghanistan, and it was supposed that the cold to which he had been exposed had induced nephritis. On examination I found a simple valve nearly occluding the deep urethra, and his urine contained a microscopic amount of pus. Dilatation of the stricture, and a few applications of nitrate of silver to the serum-sweating surface behind it, was all that was required to remove the fancied albuminuria, and to procure his appointment.
I could record several other and similar examples, but the fol lowing, which illustrates an analogous condition of the ureter, is too emphatic to be omitted: A patient aged fifty-six was brought to me to determine the cause of an intermittent htematuria, which had been noticed for some years. A very distinguished physician had examined the patient several times before, and had analyzed the urine. More than a marked trace of albumin had been found in clear urine, which was of low specific gravity, and casts had also been seen. A diagnosis of chronic Bright's disease had been, therefore, supplied to the practi tioner in charge of the case. The cystoscope revealed a tough fibro papilloma, spreading around and partly occluding the left ureteral orifice, the ejected contents of which tube were murky and contained pus and flakes. Obviously the of the ureteral orifice had induced back-pressure 'changes and mild ascending pyelitis. Urine from the other kidney showed an ordinary specific gravity (1.025) ; it was acid, clear, and contained 2.5 per cent. of urea. Thus the dis charge from the pelvis of one ureter was incautiously inferred to represent the secretions from both kidneys.