SYMPTOMS - CHRONIC CONGESTION OF THE KIDNEYS.
Of the persons who die with congestion of the kidneys a large number present marked symptoms during life, but it is difficult to determine how largely these symptoms are due to the congestion of the kidneys.
A. congestion of a few weeks' duration, such as we see with large effusions of fluid in the pleural cavities, seems to give no renal symp toms and no changes in the urine.
The question is complicated by the fact that with chronic endo carditis and pulmonary emphysema any one of the following kidney lesions may coexist: 1. Chronic congestion; 2. Chronic congestion followed by chronic exudative nephritis; 3. Chronic congestion fol lowed by chronic nephritis without exudation; 4. Chronic de generation; 5. Chronic degeneration followed by chronic nephritis with exudation; 6. Chronic nephritis with exudation not preceded by congestion; 7. Chronic nephritis without exudation not preceded by congestion.
Here are seven different kidney lesions, each one of them fre quently associated with cardiac disease.
It is always difficult and often impossible in any given case of heart disease to determine certainly which •kidney lesion exists. The general rules which we follow are these: Chronic Congestion.—The Cardiac symptoms not as severe; dropsy often present; the quantity of the urine moderately diminished, its specific gravity normal or higher than normal, albumin in very small quantities, few or no hyaline casts.
Chronic Congestion followed by Chronic Nephritis with Exudation.
The cardiac symptoms more severe; the dropsy well marked; the urine scanty, its specific gravity normal or lowered, a large quantity of albumin, and casts in variable number.
Chronic Congestion followed by Chronic Nephritis without Exuda lion. —The patients are liable to have attacks of contraction of the arteries. The dropsy is not as constant. The quantity of the urine varies, sometimes above, sometimes below the normal. Its specific gravity is low. There is but little albumin except when the arteries are contracted. Loss of flesh and strength are marked features.
Chronic cardiac symptoms.are severe; dropsy is regularly present but not always marked. The quantity of the urine varies, its specific gravity is unchanged, there is but little al bumin. The patients are feeble and anremic with a prolonged period of scanty urine, delirium, stupor, and the typhoid state.
Chronic Degeneration followed by Chronic Nephritis with Exuda cardiac symptoms are severe and the dropsy well marked. The quantity of urine is small, its specific gravity is rather high than low. Albumin is present in large quantities, casts are not so constant. The patients are feeble, aniemic, and get worse rapidly.
Chronic Nephritis either with or without Exudation, not preceded by Congestion. —In these patients there is the ordinary history of chronic nephritis lasting for months or years. Then, as the endocarditis ad vances, the heart's action becomes worse, the circulation is disturbed, and the different cardiac symptoms are added.