SYMPTOMS - CHRONIC DEGENERATION OF THE KIDNEYS.
With the degeneration caused by heart disease the quantity of the urine varies with the changes in the action of the heart and the contraction of the arteries, sometimes abundant, sometimes scanty, sometimes suppressed. The specific gravity is not diminished, nor is the proportion of urea to the ounce diminished. Albumin and casts in small quantities are more frequently present than with chronic congestion. While it is difficult to separate the kidney symptoms from the heart symptoms, yet one has the impression that this kid ney lesion is more serious than chronic congestion and has its effect in increasing the loss of nutrition and the anaemia.
. If the degeneration is followed by chronic nephritis with exuda tion albumin appears in the urine in large quantities ; the anaemia and dropsy are very marked, and the patients get worse rapidly.
When the degeneration accompanies chronic diseases, such as phthisis or cancer, the urine remains normal, or from time to time contains a little albumin and a few casts. The patients are so ill with their primary disease that the secondary degeneration of the kid neys is hardly appreciable during life.
The group of cases in which the degeneration occurs without dis coverable cause is interesting, for the kidney lesion may be the cause of death. It is a difficult group to study, because the cases are not
very numerous, and the clinical histories and autopsies are apt to be dissociated. The autopsies are for the most part in hospital patients with short and imperfect histories ; while the clinical histories are of private patients on whom it is difficult to obtain autopsies. I think, however, it can be said that the urine remains normal, or from time to time contains a little albumin and few casts, and that neither dropsy, nor a pulse of high tension, nor an hypertrophied left ven tricle, nor acute urffluaic symptoms are present.
The patients gradually, month after month, lose flesh and strength and become more or less anaemic. They may have a variety of digestive disturbances. The course of the disease is slow, sometimes interrupted by periods of improvement, but regularly getting worse from year to year. Finally the patients are so feeble that they re main in bed; they develop alternating delirium and stupor, and so die.
The diagnosis in these cases is extremely difficult. They resem ble cases of malignant disease in which no tumor can be found, and cases of chronic nephritis with normal urine and no changes in the heart or arteries.