COURSE OF THE DISEASE - CHRONIC PRODUCTIVE NEPHRITIS WITH There is hardly any limit to the variations of the disease, but the most constant symptoms are anxmia, dropsy, and albumin in the urine.
The following are some of the ordinary examples of this form of nephritis: 1. There are cases in which the symptoms are nearly continuous. The patients begin with anaemia, headache, disturbances of digestion, and a little dropsy. No one of these symptoms is at first very marked; the patient is not in bed, he does not feel very sick, but even at this time the urine contains a large quantity of albumin. As the weeks and months go on all the symptoms grow worse: the anaemia is more profound, the headaches and disturbances of digestion more troublesome, the dropsy involves more of the subcutaneous tissue and the serous cavities so that the patient becomes more and more helpless. There may be intercurrent attacks of acute uraemia with contraction of the arteries, or loss of eyesight, or a troublesome bron chitis. The ordinary duration of this form of the disease is from one to three years. The patients die with the most extreme dropsy, or in the state of chronic uriemia, or both these conditions exist to gether.
2. There are cases in which the anmita, the dropsy, and the dysp noea come on in attacks which last for weeks or months. Between the attacks the patients are comparatively well, often able to work, although the urine always contains albumin. These patients often go on for a number of years, better in the summer and worse in the winter. But each successive attack is more serious than the preced ing, and finally there comes an attack from which the patient does not recover.
3. There are cases in which a number of years before death the patients have an attack of acute or subacute nephritis with anemia, dyspncea, dropsy, albumin in the urine, and all the usual symptoms. From this they apparently recover completely and seem to be in their ordinary health. The urine continues to contain a little albu
min, or on some days the albumin disappears altogether. From year to year the specific gravity slowly falls. The exudation from the blood-vessels of the kidneys stops, but the chronic productive inflam mation of the kidneys continues. Finally, after exposure, with an accident, with a pneumonia, or without discoverable cause, all the symptoms of a subacute nephritis are rather suddenly developed, and the patient soon dies.
4. There are cases which for years have no symptoms except pal lor of the skin and mucous membranes, and urine of low specific gravity which habitually contains a moderate quantity of albumin. These patients must not be confounded with cases of simple anoemia, nor with those of persistent albuminuria without kidney disease. The diagnosis is sometimes quite difficult. The prognosis in these patients depends upon the specific gravity of the urine. If it is con stantly below 1.010 the prognosis is bad, no matter how well the pa tients may feel.
5. There are cases in which the first symptom is the attack of spasmodic dyspnoea. This may continue and other renal symptoms rapidly develop. More frequently, however, the dyspncea is palli ated or relieved by treatment. The patient then goes on for months or years with occasional attacks of dyspncea, each one more severe and harder to control, until finally other renal symptoms appear.
6. There are the cases complicated with endocarditis, myocarditis, or dilated heart. In these patients we have the association of cardiac and renal symptoms, either one predominating.
7. There are cases in which all the symptoms disappear, and the urine returns to its natural condition. If this improvement continues for a number of years it seems probable that the nephritis has come to a standstill, and that enough kidney tissue has been left unim paired to carry on the functions of the organ.