The characteristic symptoms of acute exudative nephritis are : febrile movement, with more or less prostration; headache, stupor, sleeplessness, restlessness, muscular twitching, general convulsions; dyspncea, loss of appetite, nausea and vomiting; a pulse of high ten sion with exaggerated heart action, or hypertrophy of the left ventri cle; dropsy and anminia.
When acute nephritis complicates scarlet fever or one of the other infectious diseases, the patient may already have a febrile movement belonging to the primary disease. If the nephritis is primary, or if it is not developed until the fever belonging to the original disease has subsided, there is a rise of temperature belonging to the nephritis. This fever is in proportion to the severity of the nephritis, and in children is sometimes as high as 105° F. The fever, however, does not usually continue more than a week, although the nephritis lasts longer.
Headache, restlessness, sleeplessness, delirium, and stupor during the first days of an acute nephritis seem to be of the same nature as they are in so many severe inflammations attenued with fever. But later in the disease, after the temperature has fallen, they apparently depend upon the increased tension in the arteries. In the cases of prolonged anuria, however, there is a condition of mild delirium and stupor with a soft pulse.
General convulsions are of not uncommon occurrence, especially in children. They do not usually occur until after the nephritis has existed for several clays. They are often preceded by involuntary contractions of groups of muscles. They may be preceded and fol lowed by stupor. The frequency of their occurrence does not seem to be in direct relation to the quantity of urine excreted. They may be absent in fatal anuria, and present when the quantity of urine is nearly normal. It is the rule before and during the convulsions to have a marked increase in the tension of the pulse. While general convulsions are an alarming symptom, yet a great many children make a very good recovery after having them.
Loss of appetite, nausea, and vomiting at the beginning of the ne phritis seem to be due to the febrile movement. Later in the disease it is probable that they are due to the disturbance of the function of the kidneys.
A pulse of high tension, exaggerated contractions of the heart, and sometimes hypertrophy of the left ventricle are present in some of the cases, not by any means in all of them. This disturbance of the
circulation is evidently caused by contraction of the arteries. That the contraction of the arteries is clue to the presence of irritating sub stances in the blood is probable, but not certain.
Dropsy is present in many of the cases. It is usually confined to the subcutaneous connective tissue. Its probable causes have already been discussed.
Anemia, with a pallor of the skin out of proportion to the dimi nution in the quantity of hmnoglobin, is very often seen. We are still ignorant as to the way in which an acute nephritis causes such changes in the composition of the blood.
3. Acute exudative nephritis with an excessive production of pus cells. This is not to be confounded with embolic nephritis, nor with nephritis caused by cystitis. It is only a severe variety of acute ex udative nephritis. It is seen both in children and in adults. I have seen it with scarlatina, diphtheria, and measles, and occurring with out discoverable cause.
The invasion is sudden, with a high temperature and marked prostration. Restlessness, headache, delirium, and stupor are soon developed and continue throughout the disease. The patients rapidly lose flesh and strength and pass into the typhoid state. Dropsy is slight, or absent altogether. The urine is not so much diminished in quantity as one would expect. Its specific gravity is not changed. Albumin, casts, and red and white blood-cells are present in consid erable quantities, but not always early in the disease, and they may even be absent altogether.
Although this form of nephritis is not of common occurrence, the unusual character of the symptoms and the great mortality are rea sons for calling special attention to it. It differs from the ordinary form of exudative nephritis in that it behaves like an infectious in flammation, and that, although the emigration of white blood-cells is large, the exudation of serum may be small, and so the urine may show but little change. It is probable that the nephritis is the re sult of some obscure form of bacteritic infection.
The ordinary duration of an acute exudative nephritis, which ter minates favorably, is about four weeks, but may extend to eight. The recovery is a complete one, and there is no danger that chronic nephritis will follow.