Acute urcemic attacks with contraction of the arteries, dyspnoea, vomiting, convulsions, etc., may occur at any time in the course of a chronic exudative nephritis. But they are of very much more fre quent occurrence with the non-exudative form of the disease.
Chronic urcemia, on the contrary, is one of the ordinary ways in which an exudative nephritis proves fatal. The condition belongs to the later stages of the disease. It is developed rather gradually, but when once established is permanent, not disappearing up to the time of the patient's death. The patients are in a condition of alternating delirium and stupor, with a rapid, feeble, soft pulse.
Simple or nephritic retinitis, may be developed at any time in the disease. Both eyes are regularly involved. The impairment of vision may be very slight, or considerable, •or the pa tients may become entirely blind. With such a neuro-retinitis the prognosis of the nephritis is especially bad.
Dyspncea is a nearly constant symptom, but it is not always the same kind of dypsncea, nor produced by the same causes. It may be due to hydrothorax, to oedema of the lungs, to contraction of the arteries, or to failure of the heart's action.
The dyspncea due to contraction of the arteries is common to both forms of chronic nephritis. It may be developed at any time during the course of the disease. It comes on in attacks, especially at night and in the early morning, and is worse when the patients lie down. It often begins while the patierit is apparently in good health, but is a sure premonition of serious disease.
In some cases these attacks of dyspncea can be controlled and the patient kept apparently well for months and even years. But as the
attacks are repeated, they are more severe and more stubborn. The heart's action fails in addition to the contraction of the arteries, and the dyspnoea becomes of such a character that it can only be relieved by death.
In other patients the first attack of dyspnoea is also the last. It cannot be relieved by any treatment and continues up to the time of the patient's death.
A catarrhal bronchitis with cough and expectoration is sometimes an annoying symptom. The cough fatigues the patient, and it is difficult to control it.
Loss of appetite, nausea and vomiting are frequent symptoms. When they do not already exist it is easy to cause them by the use of improper drugs.
The heart is very often affected. The disease of the kidneys after a time produces hypertrophy of the left ventricle. This does no harm until the time comes when the heart's action fails in spite of the hypertrophy, then the dyspnoea and dropsy follow.
Chronic endocarditis, chronic myocarditis, and dilatation of the ventricles are associated with chronic nephritis in two ways: they may cause a chronic congestion or degeneration of the kidney which is afterward followed by a nephritis; or the heart disease and kid ney disease are developed in the same person, neither one of them secondary to the other. In these patients it is by no means easy to tell how much of the dropsy, the dyspnoea, and the loss of nutrition belongs to the heart disease and how much to the nephritis.