Definition.—A chronic diffuse inflam mation of the kidneys, indicated by a growth of connective tissue in the stroma, degeneration and atrophy of the renal parenchyma, and by marked changes in the cardiovascular system.
Symptoms. — The symptoms may re main latent for a considerable time, even for years, while the morbid productive changes are gradually effected in the kidneys. They may not become evident until late in life, even though the kid net's may be in an advanced state of degeneration. Some complicating condi tion may also supervene, as pericarditis or pneumonia, causing the development of grave renal symptoms. As a rule, however, urmmia makes its appearance with headache, stupor, or convulsions, dyspncea, nausea and vomiting, and a tense pulse. This seizure may be re covered from. There is now an interim, of variable duration, in which there are drowsiness, lassitude, a disordered diges tion, headache, failing vision, dyspncea, and frequent micturition, with a more or less impaired general health. Then fol lows another urmmic seizure, still more severe, if not fatal. If not fatal, the general health is still more reduced, and confinement to the house or bed is nec essary; at last the vital forces can no longer compensate for the destruction of the renal parenchyma. Contracted kid ney may sometimes first be manifested by spasmodic dyspncea (urwmic-cardiac). There is a marked gradual onset of periods of drowsiness during the day that are uncontrollable; an attack of hemiplegia may be the first sign of the disease. In other cases a progressive loss of flesh and strength, with a dry, harsh, wrinkled skin, may be, from the begin ning, the only clinical features, until death results from sheer feebleness and emaciation. The variability and involve ment of the symptoms render it advis able to describe them under the various systemic divisions.
There is an increase in the daily quan tity of urine excreted so great that it causes a frequent desire to micturate, not only during the day-time, but two or three times through the night. This may be aggravated by the hyperacidity of the urine and by the irritability of the prostate gland (especially in advanced years) that are so often associated with renal cirrhosis. The total quantity of urine for the twenty-four hours may measure several quarts in marked cases of the disease. It may be slightly de
creased early in the attack, when the degeneration and destruction of the par enchyma are in their incipiency; but, as the "blood-flow to the parts that remain must, cceteris paribus, be as great as it would have been to the whole of the organs if they had been intact," excess ive pressure is brought to bear within the capillaries, owing to the compensat ing cardiac hypertrophy, and the secre tion of the urine, especially of the watery elements, becomes more active. Diabetes may be suggested by the polyuria, but the urine is clear and pale-yellow in color, the specific gravity being seldom above 1010 or 1012, and it may be as low as 1002 or 1005. Albumin occurs in traces only, or may even be absent altogether (glomerular atrophy); this is noted especially in the urine voided in the early morning. The urea is dimin ished, and there is little or no sediment. On careful examination, microscopically, there may be found a few casts (usually narrow hyaline), perhaps some leuco eytes, and, rarely, a few red blood-cells. Late in the disease or in the presence of a ursemic exacerbation or a complicating inflammation, the urine may be dimin ished in quantity, the albumin increased, and numerous casts be found in the more apparent sediment. Ilrematuria is a rare condition.
Epistaxis may form a serious symptom.
Case of cerebral hemorrhages in ad vanced Bright's disease. Symptoms of the chronic interstitial form with marks of a slight, old, retinal hemorrhage. One night the patient became quickly sleep less and delirious, and was found, the following morning, in a comatose condi tion. His temperature was slightly sub normal; there were no convulsions; the bladder was not distended; pulse, SO, small, compressible; pupils equal, a little dilated, reacting to light; no strabismus; no paralysis. Croton-oil was given, and hypodermics of pilocarpine; but the coma deepened, the breathing becoming stertorous, the chest filling with riles, and pulse and respirations failed almost synchronously. At post-mortem, to the left of the aqueduct of Sylvius, there was a small hemorrhage, of the size of a pea, flattened from above downward in its site in the pontine part of the floor of the fourth ventricle. Walsh (Med. Press and Cir., Nov. 26, '90).