ALBUMINURIA WITHOUT DISEASE OF THE KIDNEY.
The examination of the urine by the physicians of life insurance companies, and by other physicians who examined this excretion in the case of school children, of soldiers, and of other groups of persons, has brought out the fact that albumin is present in the urine in many persons who have no disease of the kidneys. These persons can be arranged in the following groups : 1. Paroxysmal or Cyclic characteristic features of this form of albuminuria are : that the quantity of albumin is large, while casts are few or absent; that if we examine the urine at regular intervals during the twenty-four hours we find a regular rise and fall in the quantity of albumin. The albumin begins to appear soon after the person rises in the morning, increases through the clay, falls after he goes to bed, disappears at night, and reappears the next day. This regular cycle can be disturbed by changing the hours of rest, of meals, and of exercise. The rule is that the appearance of the albumin is favored by exercise and by eating, while rest in bed causes it to disappear. There seems to be no way of accounting for this form of albuminuria except by supposing that there are changes in the composition of the blood, or in the walls of the renal capillaries.
The persons in whom this form of albuminuria is present are regu larly young males, who also suffer from more or less disturbance of the general health. The patients suffer from anemia, lose flesh and strength, have headaches, neuralgic pains, bodily and mental lan guor, hysteria, and disturbances of the functions of the stomach, liver, and intestines. But there is a great difference in the patients as to how far these additional symptoms are developed. In some they are but trifling, in others they are well marked.
To distinguish these patients from those who have a true nephritis is by no means easy; the diagnosis may remain doubtful for months, and even then it is difficult not to make mistakes.
The treatment of these patients consists in the regulation of the diet and mode of life and the management of the disturbances of di gestion and of the condition of the blood. The diet should be liberal and varied, but all indigestible articles of food must be excluded. Massage, hot and cold baths, and regulated exercise are to be syste matically carried out. A climate which admits of many hours' daily exposure to the open air and sunlight is to be preferred.
All disorders of digestion are to be remedied as far as possible.
The change in the composition of the blood is not marked; neither the quantity of hmmoglobin nor the number of blood-cells is much diminished; iron is of service in the treatment of the affection, but does not act as a specific.
The prognosis as regards the life and health of these patients is good, but it may be very hard to get rid of the albumin altogether.
2. Dietetic Albmiintria. —This occurs both in children and in adults. It may follow the ingestion of only certain kinds of food— cheese, pastry, and eggs; or of any kind of food ; or of any food which is not properly digested; or it may occur when exercise follows im mediately upon the ingestion of food. The quantity of albumin is small and there are few or no casts.
If this form of albuminuria is temporary, it is not a serious con dition, but if the disposition to it persists, the patients are to be re garded with suspicion. They are also liable to temporary glycosuria; they may have well-marked functional disturbance of the liver; they may have the gouty disposition; or they may have cirrhosis of the liver, or chronic endarteritis.
The treatment consists in regulating the diet and exercise in the same way as in persons with the gouty disposition; in relieving con stipation; and in the use of the drugs which are likely to increase the production of bile.
3. Albuminuria exertion must be severe and prolonged, in long and fatiguing marches by soldiers ; prolonged con tests in walking or running; violent exercises such as boxing or wres tling. The quantity of albumin may be considerable and numerous casts may also be present. It seems probable that this form of albu minuria is due to a congestion of the kidneys caused by the exertion. After the cessation of the exertion the albumin regularly disappears within a few hours or days. But a repetition of such temporary con gestions of the kidney might lead to the development of a true ne phritis.
4. Simple Persistent patients may for years have small quantities of albumin nearly every day, but not at all hours in the day. The albumin is not abundant, it often disappears after rest; there may also be a few hyaline casts. The patients have no other symptoms of kidney disease, even when they are under ob servation for years. But one always feels anxious concerning such persons. Sooner or later they are apt to develop chronic nephritis, or endocarditis, or endarteritis.