Semmola has tried to prove that albu minuria is always caused by changes of the blood characterized by abnormal diffusibility of its proteids, and, in his opinion, the pathological changes in the kidneys are consecutive to the albumi nuria. Though his theory is not gener ally accepted, Rosenbach has adopted it for the albuminuria which is not caused by nephritis, and regards it in such cases as a salutary and regulating process.
In most clinical eases different causes are simultaneously in action, and it is generally very difficult to determine which is the preponderating etiological factor.
Although albumin is not recognized as a normal constituent of the urine, it is, nevertheless, a fact that traces of albumin, and even a rather considerable amount of it, may be found in the urine of persons otherwise healthy and pre senting no symptoms of disease of the kidneys or of the organs of circulation.
Case of intense, continuous albumi nuria of seven yaers' duration in an ap parently healthy man, 67 years of age, who, seven years before, because of a little disturbance of appetite, had con sulted a physician, of whom he learned that his urine contained both sugar and albumin. There was no hereditary taint, no previous illness, no alcoholism or syphilis, that could in any way account for the urinary findings. The most care ful examination failed to reveal any le sion in any organ. Dieulafoy. who exam ined the patient, did not look upon the ease as one of Bright's disease, but as a sort of diabetic albuminuria which can be regarded as an exaggeration of physi ological albuminuria. M. de CrCsan tigncs (Jour. de MM. de Paris, p. 125, '96).
Albuminuria after exercise. Specimens of urine from 105 soldiers examined. Albumin was present in 41.73 per cent. of specimens of urine taken before drill, and in 63.23 per cent. of cases after it. Levison (St. Barth. Hosp. Rep., xxxv, 169, '99).
Albuminuria after exertion. Urine of 9 members of the Rugby foot-ball team examined after playing in the final cup tie. In every instance albumin was pres ent, and in some cases hyaline casts also. Herbert Hawkins (Brit. Med. Jour., ii, 1593, '99).
Albumin in the urine after severe exer cise. Eighty-three specimens of urine taken from oarsmen at Harvard Uni versity, when in training for races, and examined for albumin. Of these, 43 con tained albumin. After time-rows and races the urine was invariably albumi nous. Darling (Boston Med. and Surg. Jour., exli, 205, '99).
Cyclical albuminuria has been ascribed by Stirling to the sudden shock of the kidneys from the pressure of blood upon assuming the upright position on arising. The shock from sudden rising plays but slight, if any, role. Even when the up right position is assumed very slowly, albumin appears in the urine in such cases. The kidneys are merely unable to stand the increase of pressure that occurs with the upright position.
Cyclical albuminuria is not necessarily related to gout. There is also no evi dence that cyclical albuminuria, is due to a slight nephritis resulting from a previ ous attack of acute nephritis. It is a form of album inuria from venous stagna tion, the result of previous inflammation of the kidneys and lack of elasticity of the vessel-walls of the glomeruli. Ru dolph (Centralb. f. innere Med., Feb. 24, 1900).
Albuminuria following renal palpation. Renal brematuria with albuminuria noted in several cases in which the kidney had been examined bimarmally and in which no albumin had been present in the urine before examination. The pressure to which the kidney is exposed causes cir culatory changes which permit of the transudation of from the renal capillaries. C. Menge (Miinchener med. Woeh., June 5, 1900).
Many clinicians therefore admit that albuminuria may be regarded, in some cases, as physiological; this is, however, contested by as many.
Virchow described a physiological al buminuria in infants, occurring in the first days of life, and explained it by the sudden changes of circulation taking place immediately after delivery.
The children of mothers suffering from eclampsia or chronic albuminuria may show this condition from birth. In 10 children whose mothers were non-albu minuric 1 only showed traces of albumin, while in 4 whose mothers were eclamptic 3 showed albuminuria, while the mother of the fourth was only very slightly affected. Albuminuria may thus be transmitted from the mother to the child, and this condition in the child may be prolonged considerably over early in fantile life, probably preparing the way for future attacks of nephritis in the course of the ordinary diseases of child hood. Many eases of so-called albu minuria may be hereditary. Should a mother be known to suffer from albu minuria, the children should be carefully examined, and every effort made to pre vent the occurrence of scarlet fever or other febrile disorders. Fieux (Jour. de Med., July 25, '99).