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Changes in the Kidneys - Complications of Diabetes 1

albuminuria, tubes and glycogen

CHANGES IN THE KIDNEYS - COMPLICATIONS OF DIABETES.

1. Hypertrophy of the Kidneys.—See page 109.

2. Gruntdor Atiophy.—The albuminuria so often observed in cases of diabetes is by no means always a sign of the onset of grave renal diseases; neither is it permissible to refer it to the degenerations of the epithelium to be described below, for the latter belong always to the latest stages only of diabetes. The albuminuria, on the con trary, may appear so frequently in the early stages and without any accompanying disturbances that many writers look upon it as a harmless symptom (Schmitz), although they have • never yet suc ceeded in finding a satisfactory explanation of its origin.

The doctrine of the harmlessness of albuminuria in diabetes must not be established as of universal application, for it not infrequently is in fact a sign of a grave organic disease of the kidneys, almost always then of granular atrophy. It is questionable whether this is directly dependent upon the diabetes itself, the glycosuria, aceto nuria, etc., or whether it occurs consecutively to endarteritis. When the granular atrophy has reached a certain stage the glycosuria often disappears, the diabetes is cured, and the further course is that of an ordinary chronic interstitial nephritis. This termination is en

countered almost exclusively in the obese and gouty, and practically never in other forms of diabetes.

3. Glycoyenons DeyenePation.—Armanni and Cantani, and later also Ebstein, Ferraro, and others, found in cases of diabetes in which death had occurred in coma a peculiar vesicular swelling of the epi thelium in the straight tubules and in the descending portion of Henle's tubes. Ehrlich gave the name of glycogen clods (Glycogen sehollen) to these formations. The nuclei and a portion of the pro toplasm of the cells remain. There is probably a resorption of the sugar flowing through the tubules and a convers;on of the same into glycogen.

4. Fatty Degeneyation.—Fichtner has described a collection of fat granules peculiarly arranged in a row in the peripheral parts of the epithelial lining of the convoluted tubes and of the ascending por tion of tubes. The patients had died in coma. Beneke has confirmed this discovery. The relation of neither glycogenous nor fatty degeneration of the renal epithelium to symptoms observed at the bedside has yet been established.