ALBUMINURIA.
Albuminuria, albuminuria of Piorry, Bright's disease, consists, Jaccond says, in a disturbance of the renal secretion, characterized by the presence of albumin in the urine. Considered from the standpoint of pregnancy, it may, according to Dumas, be presented under two very different forms: " One, which is entirely and intimately dependent upon pregnancy itself, the other independent of it, for its primary cause; but which, by the fact of its being coincident with pregnancy, follows a definite course, and apart from its origin, develops under its influence a,s the preceding.
"Physiological pregnancy, by modifying the quality and quantity of the blood, is a predisposing general cause of albuminuria. But to produce the last, a cause must be added, and this may be due to a true patho logical state of the blood, a morbid condition of the kidney, an acci dental cause, or mechanical pressure exerted by the uterus, when it has acquired a sufficient size. The influence of labor may be similar to the, mechanical pressure at the end of pregnancy; but it can only produce this effect when the predisposing cause has exercised its previous influ ence. Finally, a woman may become pregnant when she already has albuminuria. In this case there is a double influence to consider, one ex erted by the albuminuria on the pregnant woman, and the other the influence of pregnancy on albuminuria." The conclusions of Dumas only confirm the opinion of Tarnier, who rightly admits that the albuminuria of pregnancy alone can no longer be regarded as a symptom of a single lesion, but that the passage of albumin in the urine depends, on the contrary, upon very different causes. We shall see in the section on pathogeny how many theories this question of albuminnria haa raised. However it is, we can, with Dumas, state it as settled, that three conditions are necessary for the normal secretion of urine. 1st. A normal distribution of the generated fluid, or the mechanical integrity of the circulatory system; 2d. A normal condition of the blood; 3d. A normal filtration or anatomical and func tional integrity of the kidney.
But these three conditions not being met with in pregnant women, hence the possibility of albuminuria. Moreover, albuminuria may have
existed before pregnancy. Finally, albuminuria may show itself only during labor.
Hence the division admitted to-day by almost all authors: 1st. Albumi nuria in pregnant women, with pre-existing renal lesions; 2d. Idiopathic albuminuria; 3d. Albuminuria complicating labor.
Albuminuria of Pregnancy with renal Lesions.
Pregnancy may occur in women having renal lesions before they be come pregnant, and these lesions may or may not have been suspected. Bright's disease in these cases develops more rapidly and yields more quickly to pathological manifestations. Under the influence of pregnancy renal lesions may increase more and more, and produce, Bamberger says, in a short time, marked and incurable disorders. Pregnancy becomes a powerful auxilliary cause, and Dickinson has given an exact picture of the progress of the disease.
" When the renal disease advances with pregnancy, it rarely attains a serious stage during the first gestation. Women may die, it is true, in eclampsia, but if they live, little by little the cedema will disappear, the urine will cease to be albuminous, and they will enjoy perfect health until the next pregnancy, which will lead to some accident. The cedema will then increase considerably; the patient will be more exposed to eclampsia, the complication will be slower in disappearing after confinement, and thus, at each new pregnancy, the renal symptom will become more chronic, until the albuminuria continues between the pregnancies, and the patient will then be exposed to all the complications which accompany granular kidneys." Hypolitte, who has reported a case, proves that in these cases albumi nuria does not disappear from the urine, but persists until Bright's disease has run its course in one way or another. But in these instances, as he has observed, the convulsions are not those of albuminuria gravidarum; they are urtemic convulsions and not eclamptic, and it is easy to make a diagnosis by taking the temperature, the appearance of uremia and eclampsia differing essentially as we shall see.