COMPLICATING LESIONS - CHRONIC PRODUCTIVE NEPHRITIS WITHOUT Heart.—Hypertrophy of the left ventricle of the heart is fre quently caused by exudative nephritis, but much more frequently by chronic nephritis without exudation. It must be admitted, how ever, that such au hypertrophy, although frequent, is not constant, and that with both exudative and non-exudative nephritis there may be no change in the wall of the left ventricle. The hypertrophy of the wall of the ventricle may after a time be succeeded by dilatation, or chronic degeneration, or myocarditis.
Chronic endocarditis is often associated with this form of nephritis, apparently both lesions being produced by the same causes. It may also happen that chronic endocarditis causes first chronic congestion of the kidney and then chronic nephritis without exudation.
Lungs.—Pulmonary emphysema and cirrhosis of the liver are fre quently associated with chronic nephritis.
Arteries. —One of the most important of the complicating lesions is chronic endarteritis. The relationship between endarteritis or, more properly speaking, arteritis and nephritis, and the ways in which they are associated together are not as fully understood as they should he. The principal reason for this is the failure to recognize the fact that chronic inflammation of the walls of the arteries is just as much a disease as chronic endocarditis, or emphysema, or cirrhosis of the liver.
Arteritis.
Unquestionably arteritis is more often seen associated with other diseases than by itself. It must also be admitted that it is of such frequent occurrence in old persons that it is natural to think of it as a senile change. Still farther, the use of such names as arterio-capil lary fibrosis and arterio-sclerosis have helped to prevent us from classing arteritis with the other chronic productive inflammations.
Chronic inflammation may involve the entire aortic system of arteries, or it may be confined to a part of that system.
If a large part of the aortic system of arteries is involved, then the patients suffer from symptoms which seem to depend partly upon the changes in the arteries, partly upon attacks of contraction of the arteries, partly upon hypertrophy of the left ventricle of the heart and heart failure, partly upon the obstruction to the passage of blood through the cerebral arteries.
The clearest idea of general arteritis as a disease is to be obtained by observing it in persons not over forty years old, who have no com plicating lesions.
At first for a number of years these patients suffer only from im paired nutrition, a disposition to become anaemic, and attacks of dyspncea. It can be seen and felt that the walls of the temporal and radial arteries are thickened and that the left ventricle of the heart is hypertrophied. At the times when the patient has dyspncea the ten sion of the pulse is much increased.
For a considerable length of time the nutrition and the anaemia can be improved by climate and by diet. The attacks of dyspncea can be controlled by the drugs which dilate the arteries. But sooner or later the patients get worse. Some of them get up a dyspnoaa that cannot be controlled, the action of the hypertrophied heart fails, and the patients, after suffering for weeks or months with the most dis tressing symptoms, die. In other cases death takes place with cere bral symptoms—sudden unconsciousness, or aphasia, or hemiplegia. After the death of these patients no lesions of any consequence are found except the changes produced by chronic inflammation of the walls of the arteries.
It is evident that the symptoms and death of these patients are due to the changes in the arteries, that the disease from which they have suffered is chronic arteritis. But it is also evident that their symptoms—loss of nutrition, contraction of the arteries, hypertrophy of the left ventricle, dyspncea, heart failure, uncon sciousness, aphasia, hemiplegia—are also the symptoms of chronic nephritis.
Still further we find that many patients with these symptoms do have both arteritis and nephritis. In any given case with these symptoms, therefore, it is a matter of importance to determine whether the patient has arteritis alone, or nephritis alone, or both diseases at the same time.
Patients who have chronic nephritis are more liable than are other persons to attacks of pericarditis, bronchitis, and gastric catarrh.