SYMPTOMS - ACUTE PRODUCTIVE OR DIFFUSE NEPHRITIS.
Of the patients who suffer from this form of nephritis, a certain number behave as if they had a simple exudative nephritis.
There is a rise of temperature, with more or less prostration. Cere bral symptoms are marked—headache, stupor, sleeplessness, rest lessness, muscular twitchings, and general convulsions. The arteries are contracted, the pulse is of high tension, the heart's action is exag gerated, the left ventricle may be hypertrophied, there is dyspncea. The appetite is lost, there may be nausea and vomiting. The urine is scanty or suppressed, it is colored by blood and contains much al bumin and many casts. The patients are very sick and much more likely to die than they are with an exudative nephritis.
Such a nephritis may, however, apparently run its course. At the end of four weeks the symptoms subside and the patients get better. They may then remain in ordinary health without renal symp toms for weeks, months, or years. But sooner or later they have another acute attack, or they gradually develop the symptoms of a chronic nephritis.
The more ordinary cases have a gradual invasion, and run a sub acute rather than an acute course.
In some of the patients at first there are only loss of appetite, headaches, and an increasing pallor of the skin and mucous mem branes ; the dropsy does not come on until after many days.
In some of the patients dropsy of the legs is the first and, for a time, the only symptoms. They continue to eat well, feel well, and attend to their work.
In most of the patients dropsy of the legs and face, anaemia, head ache, sleeplessness, loss of appetite, nausea and vomiting are devel oped at about the same time.
The urine is only moderately diminished iu quantity; it often con tains no blood, there is a large quantity of albumin and a considera ble number of casts. The specific gravity remains normal, or falls a little.
The cases vary a good deal as to their severity.
Some of the patients are not at any time very sick. A moderate subcutaneous 'Oedema, anaemia, headache, and disturbances of diges tion last for a few weeks, then disappear, and the patients seem to be well. Some of them do get well, but the majority either have other attacks of the same character, or develop the symptoms of chronic nephritis. It is surprising for how many years some of these patients
go on in apparent good health, although the kidneys are really be coming more and more diseased.
In some patients the dropsy is much more extensive and involves the serous cavities as well as the subcutaneous tissue. For a num ber of weeks these patients are in bed and very badly off. And yet even the bad attacks may subside altogether, the patients are appar ently well, are able to go back to their work, and have no more trou ble for years.
In some patients there is first a well-marked attack of dropsy, anmmia, headache, sleeplessness, loss of appetite, nausea and vomit ing, which lasts for a few weeks. Then the symptoms subside and the patients are pretty well, but not very well. After this they have at tacks of the same kind at intervals of weeks or months, and this may go on for years. In hospital patients the attacks regularly come on every winter and the patients are comparatively well in the summer. Each attack, however, is worse than the preceding, and finally there comes an attack which proves fatal. In these long cases the specific gravity of the urine becomes lower from year to year.
The severe and progressive cases are most distressing to witness. The patients are constantly getting worse, and yet months may elapse before their sufferings are terminated by death. The color of the skin and of the mucous membranes becomes more and more white; headaches are constant and troublesome; sleep is difficult and unre freshing ; the eyesight is impaired or lost altogether; there is no ap petite but rather constant nausea and irritability of the stomach ; from time to time the arteries are contracted and there is a disposi tion to muscular twitchings and general convulsions. The dropsy constantly increases no matter how large the excretion of urine. The subcutaneous connective tissue is everywhere oedematous and the serous cavities are filled with serum. It seems as if the blood serum was unable to remain in the vessels, it escapes everywhere.