Symptoms.— The symptoms of an acute parenchymatous nephritis may persist in a lesser degree until the con dition becomes a chronic one; particu larly is this true of the albuminuria, the andemia, and the dropsy. As a rule, however, the disease develops slowly and gradually, and in a subacute manner, although there is seldom an early indi cation of renal derangement. There may be merely a loss of appetite, attacks of indigestion, nausea, headache, dull ness, perhaps some pallor, and a general impairment of health and strength. The complexion then takes on a blanched appearance and there is soon puffiness of the eyelids or swelling of the feet or ankles, or both. There is a gradual ex tension of the oedema up the legs, and as the day grows it becomes worse; on rising in the morning it may have en tirely disappeared. In the majority of cases the quantity of urine is diminished. In the later stages of the disease, how ever, it may be nearly or quite normal, and in protracted cases of pale contracted kidney, or when absorption of the drop sical effusion is in progress, it may even be slightly increased.
An acute nephritis supervening upon the chronic condition may now cause a very scanty or suppressed secretion of urine. In cases of scanty urine the spe cific gravity is, of course, increased, and vice versa. Albuminuria is often present to a decided degree. The albumin may constitute from one-fourth to three fourths of the urine in volume, or from 1 to 3 per cent. by weight; thus the daily loss of albumin may be consider able.
The albuminuria of Bright's disease is always characterized by great oscilla tions in the quantity of albumin ex creted at different hours of the day, be cause either of the richness of alimen tation in nitrogenous substances or of causes that escape us and should be classed among hternatogenous albumi nurias. Semmola (Inter, klin. Rund., Jan. 17, '89).
In many instances where those au thorities claim to obtain an albuminous reaction in normal urine they are really dealing with much. Plosz (Orvosi Hetilap, Nos. 42 and 43, '90).
The clinical significance of albuminuria as a symptom has undoubtedly dimin ished during the last twenty years. Cases of "functional" albuminuria con stitute from one-half to one-third of all the eases of albuminuria that come under notice. Ralfe (Brit. Med. Jour., Feb. 20, '93).
Six cases in which autopsy showed the presence of Bright's disease, and in which the urine, carefully examined dur ing life, showed, at certain times, no albumin, although symptoms of urcemia were present. These observations, to gether with similar ones of Lepine, Lan cereaux, and others, tend to show that albuminuria, is not always a faithful symptom in nephritis. Dieulafoy (Bull.
de l'Acad. de Med. de Paris, June 6, '93).
Certain eases of Bright's disease may exceptionally, and sometimes for a rather long period, show no albumin in the urine; but there may sometimes be renal insufficiency without serious renal lesions. Too often a case is diagnosed as a contracted or enlarged waxy kidney, when the autopsy shows but slight le sions; diagnosis should only have been renal insufficiency. Lepine (Lyon Med., July 9, '93).
Casts are invariably present when a true organic lesion exists. Cardiovas cular tension is another symptom almost invariably present in the early stages of renal cirrhosis. Occipital headache, with momentary attacks of vertigo, is rarely absent. In addition, there is usually a somewhat ill-defined appearance of want of perfect health, restless movements, coated tongue, foul breath, pale lips, and lifeless or waxy appearance of the skin. Danforth (N. Y. Med. Exam., Aug., '93).
Albuminuria is absent in the inter stitial forms, while the skin is frequently dark in color in the parenchymatous forms. Dabney (Inter. Med. Jour., Nov., '93).
There is a non-albuminuric nephritis exclusive of the cases of typical fibroid kidney. In this form of nephritis albu minuria may be completely absent, while signs of renal insufficiency, and even uremia, may appear. The urine is di minished and sometimes highly colored, but there is no cardiac weakness. Stew art (Med. News, Apr. 14, '94).
No albumin is to be found in the urine in some cases of nephritis. Such a ne phritis may be due to the introduction of a specific virus from the external geni tals. Fienga. (N. Y. Med. Record, Apr. 21, '94).
Rapid elimination of such substances as iodide of potassium, quinine, turpen tine. and the bromides shows that the kidney is healthy, while delayed or diminished elimination gives sufficiently precise information as to the degree to which the organ is affected. Bassett (N. Y. Med. Record, Apr. 21, '94).
Presence or absence of albumin in the urine is not nearly of as much diagnostic and prognostic importance as the mor phological evidence of kidney disease afforded by the presence or absence of casts. Ludwig Bremer (Med. Review, June 29, '95).
The quantity of urea is much dimin ished. The urine contains an abundant sediment, consisting of urates, casts, red and white blood-corpuscles, epithelial cells, granular debris, and fatty granular cells, and is in color turbid and some times smoky-yellow. There are tube casts of different varieties, the narrow or broad hyaline, fatty granular, and epithelial casts being most commonly noted.