Gull and Sutton have shown very clearly the frequency with which changes in the arteries and capillaries —arterio-capillary fibrosis—are associated with the atrophic form of Bright's disease; and that these changes in the arteries and capillaries may also exist and give symp toms without any lesions of the kidneys. From these facts they have drawn the conclusion that this form of Bright's disease is not, properly speaking, a disease of the kidneys, but rather one of the arteries and capillaries.
Bartels uses the name of "The Diffuse Diseases of the Kidneys," with the subdivisions of Hyperemia, Ischmmia, Acute Parenchyma tous Nephritis, Chronic Parenchymatous Nephritis, Renal Cirrhosis, and Amyloid Degeneration.
Active hypercemia is, he says, a condition which arises solely as the result of some toxic influence, most frequently from the use of cantharides. Apparently he has little or no personal experience of the anatomical changes found in the kidneys.
Passive hypercemia is the same condition as that called also chronic congestion of the kidney, and cyanotic induration of the kidney. Its most important form is that due to valvular lesions of the heart and to certain affections of the lungs. He makes no new statements concerning the pathological changes.
Ischcemia is the condition of more or less complete stoppage of the arterial blood-supply to the kidneys, occurring independently of con gestion of the nervous system. It occurs only in the asphyxia stage of cholera.
Acute Parenchymatous Nephritis.—Under this name Bartels in cludes all the cases of acute Bright's disease. He says that the only essential and constant microscopical appearances are the changes in the epithelium of the tubes. The epithelial cells are swollen and cloudy, they are infiltrated with granules of fat, and are broken down. To these changes in the epithelium are frequently added a swelling and infiltration of the stroma, casts in the tubes, and extravasations of blood.
Chronic Parenchymatous Nephritis.—This may follow acute paren chymatous inflammation or may begin as a chronic process. The kidneys are large, white, and smooth. The tubes are dilated; the epithelium is only partly preserved, and the cells which remain are large, granular, and fatty. In many places the epithelium is com pletely gone and in its stead the tubes are entirely filled with masses of detritus mixed with oil-globules; casts are found in many of the tubes. The stroma is thickened by fluid exudation, by an emigra
tion of white blood-cells, and by a growth of now connective tissue. The small arteries and Malpighian tufts are often the seat of waxy degeneration.
Renal Cirrhosis.—The kidney is very much diminished in size, especially the cortex. This diminution in size is clue to the wasting of the glandular tissue, while at the same time there is an extensive growth of new fibrous tissue. The change in the kidney is due to a primary growth of the intertubular connective tissue, and this leads to the dwindling of the substance of the gland, a wasting preceded by no inflammatory swelling of the organ.
To Cohnheim belongs the merit of drawing attention to the im portance of the glomeruli in acute nephritis, and to the changes which are found in them. He also points out clearly that well-marked symptoms of acute nephritis may exist during life, although no struc tural changes are found in the kidneys after death.
Langhans, Nauwerck, and Friecllhnder have developed still further the doctrine of glomerulo-nephritis, and have described in detail the lesions found in the glomeruli.
Ziegler describes : 1. Giomendo-nephritis, occurring either by itself or combined with changes in the epithelium of the tubes or with exudation of inflam matory products into the stroma.
2. Chronic Parenchymatous Nephritis.—The common feature of this form of nephritis is that there is a continuous inflammatory exudation from the blood-vessels, and that changes go on in the epithelium of the kidney.
As subdivisions of parenchymatous nephritis he distinguishes : The inflammatory, fatty kidney; Chronic hemorrhagic nephritis; Chronic glomerulo-nephritis.
3. Chronic Indurative Nephritis.—The inflammation leads to a new growth of connective tissue in the stroma, and an atrophy of the tubes and the glomeruli.
4. The Arterio-sclerotic Contracted Kidney.—In this the changes begin in the walls of the arteries; they are thickened, their lumen is narrowed or obliterated. As a result, smaller or larger numbers of glomeruli become atrophied, with the kidney tissue belonging to them. The stroma is not much thickened.