Pathological Albuminuria. — Patho logical albuminuria is found in patho logical changes of the blood—as anae mia, leukaemia, pseudoleukmmia, scurvy, icterus, and diabetes—even when the kidneys do not present pathological changes.
It is also found in many disorders of the nervous system, as epilepsy, mi graine, psychosis apoplexy, neurasthenia, and Basedow's disease, etc. Delirium tremens has also been mentioned as a nervous disease often complicated with albuminuria.
Delirium tremens is always accom panied by fever and is probably provoked by a microbic toxin or an autointoxica tion. Jacobson (Hospitalstidende, p. 193, '97).
Although the kidneys, theoretically, are believed to he healthy in the diseases mentioned above, there is no doubt that albuminuria, in many cases of this class, is caused by pathological changes of the kidneys.
In all febrile and especially in all in fectious diseases albuminuria is a very frequent symptom. It has been noticed in enteric fever, diphtheria, variola, after vaccination, in erysipelas, influenza, rheumatic fever, etc. In these cases the albuminuria is caused by changes in the composition of the blood, increase of blood-pressure, rise of temperature, and finally by changes in the structure of the kidneys, especially of the tubular epithelial cells.
Albuminuria has been observed in diseases of the intestines, dilatation of the stomach, ileus, ruptures, etc., and in renal venous congestion caused com monly by disease of the heart or the great vessels.
Albuminuria may be produced by in testinal disorders in children ; may be due to the injurious action on the renal epithelium of the toxic products of ab normal fermentations. Jacobi (N. Y. Med. Jour., Jan. 1S, '90).
It is present in all diseases of the kidneys. Acute as well as chronic albu minuria is generally found, whether the diffuse form of nephritis or as circum scribed diseases—such as infarctus, ab scesses, or tumors—be present. After retention of urine the portion of urine first passed is frequently albuminous.
Certain remedies may also give rise to albuminuria.
Case of a syphilitic subject who, after antisyphilitic treatment with 4 ai, ounces of mercurial ointment and the iodide of potash, developed cedcma, of the lower extremities, and S per cent. albumin in the urine. Another attempt at treat ment by inunction caused the albumin to increase to the enormous quantity of 60 per cent.; after discontinuing it he slowly recovered, while the albumin de creased decidedly in amount. Saalfeld (Deutsche med.-Zeitung, No. 1, '95).
Chlorate of potash, which is often used to prevent mercurial stomatitis, is fre quently the cause of the appearance of albumin in the urine. Case of a young physician who died after employing small quantities of this drug in a mouth-wash. Acute poisoning by this drug is easily recognized by the large quantity of al bumin and blood in the urine. Mankie wicz (Deutsche med.-Zeitung, No. 1, '95).
Case in which albuminuria and urmmia were apparently produced by the applica tion of a blister. Huchard (Revue de Ther. Mcdico-Chir., Apr., '96).
Examination of ROO specimens of urine derived from 201 syphilitic men, 79 syphilitic females, and 35 persons who were not syphilitic. Albuminuria found in 25 of the men, and in the women marked albuminuria in 4 cases. In 35 cases of bubo, the urine of which was examined 363 times, a trace of albumin was only found on 2 or 3 occasions. The administration of mercury in no case gave rise to very marked albuminuria. Lewin, who has used hypodermic injec tions 80,000 times with sublimate, has never seen nephritis result. It seems evident that the bichloride is the prefer able preparation for hypodermic injec tions. Julius Heller (Schmidt's Jahr biicher, No. 1, '97).
The prognosis and treatment of albu minuria, therefore, depends entirely on the origin and causes of it, and the reader is referred to the various diseases in which it occurs as a symptom.
Tests. — By means of the tests com monly employed the presence of min in the urine is revealed, but no attempt is made to discern between the different proteids; the differential diag nosis between the serum-albumin, glob ulin, etc., will be given later on.
The sample of urine to be examined must be very limpid without deposits of any kind; if this be not the ease, the urine should be filtered previous to the examination, because a slight cloud of coagulated albumin will only be discern ible when the fluid is very clear before the reagent has been added. When the urine contains many bacteria, even re peated filtration will be insufficient to make it clear; this can then be done, however, by addition of a solution of sulphate of magnesia and of carbonate of soda. By shaking the mixture a precipitate of carbonate of magnesia is formed, and when this is removed by filtration the filtrate will be perfectly clear. In many cases a few drops of caustic soda will clear the urine, but urine treated in this manner will not give a precipitate of albumin by boiling, while the test of Heller is practicable also in this case.