BRIGHT'S DISEASE.
Acute Nephritis.
Definition. — An acute inflammation of the kidneys, and either of a mild, severe, or grave character. It may be more or less diffuse in nature. Three varieties of acute renal disease are de scribed by Delafield under the term acute Bright's disease: (1) acute degen-• eration of the kidneys, (2) acute exuda tive nephritis, and (3) acute productive nephritis.
Symptoms.—The onset is sudden, as a rule, but varies with the exciting cause of the nephritis. Chilliness, nausea and vomiting, pain in the back, and, within twenty-four hon•s, dropsy are seen in sonic cases. Children are subject to con vulsions (urmmic), and in severe cases adults are no less liable. Fever may be present, but it is neither constant nor high. The early appearance of oedem atous puffiness of the eyelids and face, and of pallor of the skin, is character istic. Soon, and sometimes at first, a swelling occurs about the ankles and legs, and in severe cases dropsy involves the whole body. The scrotum, penis, or labia may, in such cases, become enor mously distended, the skin presenting an almost translucent appearance.
Often local symptoms are absent, as pain and tenderness in the lumbar re gion: they are never marked. Illicturi tion may be frequent and accompanied by a slight burning and vesical tenesmus, ,due to the concentrated urine. In very severe dropsy the tense, dry skin may become sensitive or even painful on pressure. Bodily movements are often painful and difficult in cases of marked anasarca. Urwmia may be heralded by intense headache and backache.
A urinary examination is always nec essary, as in mild cases the renal con dition may be overlooked. There may be no further symptoms than a general malaise.
The urine in acute nephritis furnishes characteristics. The total quantity passed in twenty-four hours is diminished, and may even be very scanty, varying from 5 to 25 ounces (150 to 740 cubic centimetres). There may be suppression in cases of toxic origin, when an acute degeneration or necrosis of the renal epithelium occurs, and in the very severe exudative inflam mations.
The specific gravity is early increased to 1025 or more, though later it may fall to 1015 or 1010. The color is darker than normally and is usually smoky red, or reddish brown, according to the of blood contained. A more or less abundant flocculent sediment ap pears on standing, if the normal mor phological constituents are present in great quantity.
Some red blood-corpuscles and renal epithelium are found microscopically, together with the characteristic hyaline, blood, and epithelial tube-casts. The urine is acid in reaction, and on boiling throws down a thick, curdy precipitate of albumin, which varies in weight from to 1 per cent. The urea is dimin ished.
There may also be other symptoms during the course of acute Bright's dis ease, as those of hydrothorax, ascites, and hydropericardium, in cases in which great general oedema is present. The first-named condition is bilateral and gives rise to dyspncea; the second in creases the dyspncea by pressing the diaphragm upward; and the last im pedes the heart's action. Strumpell describes a form of pneumonia that sometimes develops in severe cases of acute nephritis,—a "stiff inflammatory cedema,"—midway between lobar and broncho- pneumonia. There may also be oedema of the conjunctivae, soft pal ate, and larynx.
The pulse is often hard and tense, and, though slow at first, it may become accelerated later. Cardiac hypertrophy may be present in a slight degree. The aortic second sound is accentuated. Epistaxis appears occasionally, and sub conjunctival haemorrhages sometimes follow unwitnessed uripmic convulsions. Dryness and urremia of the skin form a constant condition. Urremic manifesta tions may supervene at any period in the disease, appearing early in the most severe cases, with intense headache and backache, vomiting, and convulsions.