The above may be considered a de scription of the common form of acute nephritis resulting from exposure: the clinical course differs somewhat in other cases. Occurring as a complication of the infections fevers, except scarlatina, acute nephritis may be characterized by the very slight degree. or even by the absence, of dropsy. Albuminuria, ham aturia, anmmia, and uremia mark the graver affections. In scarlatinal nephri tis, however, anasarca is common, and a slight oedema, at least, is quite con stant. Mild affections show simply a slight quantity of albumin and a few hyaline casts, indicative of the paren chymatous degeneration. The typhoid state may follow the subsidence of the acute toxic symptoms in cases of degen erative nephritis due to mineral poison ing; this is marked by prostration, mus cular twit chings, stupor, coma, and death. TIrematuria may be pronounced in the so-called nephro-typhoid condi tion, in which typhoid fever begins with marked symptoms of acute nephritis. The nephritis of pregnancy, as a rule, is gradual in its onset. The albumin increases in quantity from month to month, reaching a high percentage dur ing the eighth and ninth. Some hyaline casts are found; but otherwise there are few morphological elements. Red blood corpuscles rarely may be seen in the urine. ITp to the time of delivery the danger of eclampsia is constant, but re covery is rapid in uncomplicated cases after the birth of the child.
In acute (productive) nephritis, where there is a tendency to the formation of patches or wedges of fibrous tissue, there is a higher fever, there are cerebral and circulatory disturbances of a typhoid nature, as well as anaemia, dropsy, and a highly albuminous urine, even though there be no blood-corpuscles and few casts. Dropsy is most marked in the legs. There are a progressive and rapid loss of flesh and strength, dyspncea, vomiting. diarrhoea, and convulsions or coma and end in death. Milder cases last from two to four weeks, and appar ently recover; albumin and casts per sist, however, until another and a simi lar attack occurs after an interval of weeks or months. Thus, the first acute attack is subject to chronic recurrence, until a fatal seizure takes place.
Etiology.—Acute nephritis more often appears before than after the middle time of life, though it may occur at any time. Males are more often attacked than females.
Analysis of 270 cases of Bright's dis ease. Nephritis occurred more frequently in males than in females (3.309 to 2.74); most common during the period of great est activity of the body. Of the 270 cases, 140 were acute, 35 being hmmor rhagic. Of these 140 cases of acute disease, 70 per cent. could be traced to acute infectious diseases, only 2.85 per cent. being directly traceable to cold. Agnes Bluhm (Deutsches Archly f. klin. Med., B. 17, H. 3, 4).
Of 251 eases of chronic nephritis ob served by Heubner in Leipzig, 214 occurred in adults and 37 in children.
He subsequently saw 23 cases in children in Berlin, mostly after scarlet fever. Of these 65 eases, there were 3 of paren chymatous nephritis, 4 of contracted kidney, and 5 of chronic hmmorrhagic nephritis. Brill and Libman (Jour. of Exper. Med., Sept. and Nov., '99).
Occupations necessitating exposure to cold and wet offer special predisposing conditions. The long-continued use of alcohol will also, as a rule, prove a pre disposing cause of acute Bright's disease.
Among the exciting causes of acute. diffuse nephritis are:— 1. Those acting on the skin, as cold, dampness, extensive burns, and chronic skin diseases. It is often difficult to determine the relative influence of alco holic excesses and the exposure incident thereto. Acute intoxication from beer drinking may result in an acute nephri tis, but it is yet likely that in most cases the exciting cause is the cold acting upon the individual in his exposed and maudlin condition. Acute nephritis may also be caused, at times, by exposure to cold and wet apart from and in the absence of alcoholic indulgence; in such cases it is to be presumed that there is an inherent weakness of the kidneys, or a susceptibility rendering these organs the vulnerable point in the system.
The physiological toxic agents embrace the poisons of the acute infections; in a majority of cases, however, scarlet fever is the primary affection. Usually the nephritis appears during the second or third week of convalescence, though it may supervene at the height of the dis ease.
Among 97 cases of scarlet fever, but 4 exhibited the symptoms of Bright's dis ease. Of 45 cases of measles but 1 evinced renal involvement. In 162 cases of erysipelas, Bright's disease occurred 7 times and simple albuminuria 17 times. Among 481 cases of variola it appeared but once: in a child 12 months old. In 93 eases of diphtheria it occurred but 4 times and simple albuminuria but 0 times. Of 74 cases of tonsillar angina, 4 cases presented evidence of nephritis and 20 were albuminuric. Among IO cases of ulcerative endocarditis it oc curred once. Out of 360 cases of acute rheumatism, but 4 were affected second arily by acute Bright's disease. Acute nephritis is not rare in acute pneumonia, occurring in 26 out of 140 cases. Agnes Bluhm (Deutsche Archie f. kiln. Med., B. 17, IT. 3, 4).
Very grave nephritis supervening in the first seven days of scarlet fever, thus differing from the late nephritis; to it must be ascribed the fatal termination sometimes noticed in the early stage of scarlet fever. Inflammation extending to the papilla constitutes the most essen tial characteristic; leads to retention of urine and dilatation of the canaliculi. Aufrecht (Rev. des Sci. MM. en France et a l'Etranger, July 15, '04).