Summing up the causes of albuminuria in pregnant women, we can say with Dumas: lst. Pregnancy is a predisposing cause of albuminuria: a. By the age at which it occurs; b. The disturbances in the stomach, lungs and nervous system which accompany it; c. The modifications in the quality and quantity of the blood which are the result; d. The nature of the albuminoid material introduced into the circulation; e. The con gestion of certain organs which this state of blood induces. Women are, during pregnancy, predisposed to albuminuria.
2d. Pregnancy is an efficient cause of albuminuria. a. In primiparte; b. By the functional relations which exist between the uterus and the kid neys; c. By the increase of urinary secretion; d. By the mechanical pressure of the uterus, (in primipara3, twin pregnancies, retroversion, hy dramnios, rachitis; c. By morbid conditions which may accompany it and to which it may always give a serious aspect (pernicious antemia, diseases of the heart).
3d. Pregnancy may act at the same time as a predisposing and exciting cause, whenever there exists one of the occasional causes which we have enumerated. Hence: a. Albuminuria dependent upon changes in the blood, (albuminuria in the early part of pregnancy, albuminuria or dyscrasia of pregnancy).
b. Albuminuria dependent upon anatomical and functional changes of the kidneys (qrganic albuminuria of pregnancy).
c. Accidental albuminuria of pregnancy.
d. Mechanical albuminuria of pregnancy (albuminuria in the last months of pregnancy).
first a,nd only valid one is the presence of albumin in the urine. There are two methods for analysis, heat and nitric acid; but if one wishes to be more exact, he must adopt the method of Petit or Ritter. [The descriptions of these methods are omitted, and our readers are referred to works on medical chemistry for methods of estima ting the amount of albumin in the urine.—Ed.] Other symptoms are the general condition of the patient, who is chlorotic or antemic, with various digestive disturbances, and becomes gradually pale and feeble. Next, cedema appears; first in the lower extremities, slowly becomes general, and invades the face, so that the patient presents a characteristic appearance.
CEderna remains permanert in these localities, but it may vary in its amount, and even collect in the serous cavities, and there may be general anasarca. But puffiness about the face is never absent. The pulse, small, hard, thready, quick, is, in some cases, particularly when eclamp sia is imminent, almost imperceptible. Finally, there may be hemor
rhages, epistaxis, hmaturia. Thirst is excessive, digestive disturbances are very pronounced, and may be accompanied by pain in the epigastric region, and alternately obstinate constipation or a persistent diarrhcea. Next the respinitory functions are more or less disturbed, there is dyspncea, cough, and lastly neuralgic pains appear, cephalalgia, indistinct vision even to blindness, stupidity and deafness. These last symptoms generally an nounce eclampsia, but they are often slightly pronounced, and albumin nria may pass unperceived if the urine is not carefully examined.
This is, indeed, a precaution that should be taken in all pregnant women, particularly primipanc. The examination should be repeated at intervals, above all at the end of pregnancy. for at this time albuminuria is most likely to show itself, although it sometimes appears earlier. Prestat reports cases in second rnonth, Bach in sixth week, Cazeaux at four months, Cohen and Peter at five months. As a general rule it ap pears sooner in primipara3 than in multipar. Another reason for exam ining the urine at frequent intervals, is that the quantity of albumin which may be found is variable, not only from one day to another, but from moviiing to evening. Albuminuria may disappear completely for a time to reappear again in greater quantity. Its duration may be very tran sient, sometimes only for a few days or hours but more often for five or six weeks, increa,sing up to the time of confinement, to disappear entirely in three or four weeks after labor. This is not always the ease, and we have seen it once persist after confinement. Tarnier has seen it last fif teen months.
We confined, six months ago, a patient in whom albuminnria still per sists. Finally, albuminuria alone may kill the patient, as observations show.
The greater the albuminuria, the more quickly will pregnancy be in terrupted.
In the twenty-eight cases cited above from Hoffmeier, only ten went to full term. In eight of these the pregnancy was interrupted in the ninth month (the Germans count pregnancy by the ten lunar months), and in nine at a time when the fcetus was not viable; and of eighteen women who died, five went to the end of their pregnancy; in five pregnancy was interrupted in the ninth, or from the ninth to the tenth month; three before the beginning of the ninth month.
Of forty-five cases of pregnancy with nephritis: pregnancies going to term, fifteen; premature confinements, thirteen; abortions, seventeen.