Physiological allmminuria believed to be due to ingestion of a greater amount of albumin than the individual can per fectly oxidize, result being excretion of albumin. The habit of overeating is usually associated with this condition. IV. If. Porter (Columbia Med. Jour., vol. xx. No. 4, 'Os).
The mass of evidence which has come to us of late from the autopsy-table shows conclusively that chronic nephritis exists and is an unrecognized cause of death in a proportion of eases far beyond ordinary belief, and the comparison of carefully kept records of cases before (heath with autopsy findings shows that little reliance can be placed on the mere urinary examination, either positive or negativ e. as a means of absolute diag nosis or prognosis of Bright's disease. The writer's own experience leads him to believe that (I) Bright's disease may exist without the ordinary urinary manifestations,—viz., albumin or casts: (2) albumin and casts may be found in the normal urine and do not necessarily mean Bright's disease; (3) given a case of chronic Bright's disease with albu minuria, the fact of its presence, its con stancy. or its amount has absolutely no prognostic significance. C. A. Tuttle (Jon•. Amer. Med. Assoc., Mar. 31, I900).
Series of experiments show that the albumin present in nephritic urine is derived from the blood and is different from the specific kidney albumins. L. Aschoff (Lancet. Sept. 6, 1902).
It is characteristic of physiological albuminuria that the quantity of albu min is generally small and that the ex cretion is, in most cases, intermittent, or cyclical. Leube, Pavy, Fiirbringer, Klemperer, and many other authors have studied this condition.
Pavy introduced the denomination "cyclical albuminuria" for the cases in which the albuminuria ceases and re turns at regular intervals.
Case of a chlorotic girl, 15 years old, in whom albuminuria was of the cyclical type: albumin appeared about 11 A.M., and reached a about 3 o'clock in the afternoon, diminishing thereafter until it disappeared completely by S o'clock P.M.. and remaining absent dur ing the night. Recalling an observation of Ileubner's, who found cyclical albu minuria in several members of the same family, the author examined the urine of two sisters and two brothers of the patient and found the same condition in one of the sisters, a girl of 13 years, also chlorotic. Treatment of the chlorosis had no effect upon the albuminuria.
Schon (Jahrbuch f. Kinderh., B. 41, S. 307. '96).
Pavy likewise insists upon posture as the invariable cause of cyclical, or in termittent, albuminuria, the excretion ceasing when the subject is in the re cumbent position and going on only when he is walking or standing. The cycles are commonly completed within the day, but in a case narrated by Kiem perer there were two cycles, the maxi mum of albuminuria taking place in the forenoon and afternoon.
Effect of rest in bed: in one case, in a girl S years of age. of wasting and loss of appetite, the average daily amount of albumin passed for five clays, while the child was running about, was 51 centi grammes. She was then kept in bed for five days, and the average daily amount of albumin sank to 4 centigrammes; in the next five days, during which she was running about again, the average daily amount of albumin rose to 36 centi grammes. The fall on going to bed and the rise on getting up were immediate. The proteids present in the urine in these cases are serum-albumin, cerium globulin, and nueleo-albumin. Keller (Jahrb. 1. Kinderh., B. 41, p. 356).
In many instances bicycling gives rise to an albuminuria that cannot be dis tinguished with the microscope from that of genuine kidney disease, hut one that must be looked upon as physiological, since it disappeared within a few days after cessation of the exertion. leaving absolutely no signs of disease. Observa tions made on twelve bicyclists, eight of whom were trained and four untrained. Among the eight trained wheelmen there was only one whose urine contained al bumin before the exercise, but after it the urine was albuminous in seven. In six of them, including the one whose urine was free from albumin, there were at the same time present in the urine casts in numbers as great as are gener ally met with in acute or chronic paren chymatous nephritis; and the two others had a few hyaline casts. Most of the casts were hyaline; the minority showed distinct renal epithelia and were granu lar. Free renal epithelia were found in every instance. White blood-corpuscles appeared sparingly, but red corpuscles were not met with at all. Among the four untrained wheelmen, in all of whom the urine was free from albumin before the exercise, two showed albuminuria and one cylindruria after riding from an hour and a half to three hours. Mueller (Mtinchener med. Woch., No. 43, '96).