The outlines of the individual capil laries are lost, and the glomerular epi thelium of the capsule—especially that covering the inside of the capillaries of the tufts—is swelled and opaque. New epithelium appears in most instances of diffuse exudative nephritis, and a res toration of the glomerular function oc curs. According to Delafield, in the productive variety of acute diffuse ne phritis, however, certain lesions are more permanent in character from the outset in the glomeruli and stroma, and hence the increased gravity of the disease. Superadded to the usual exudative con dition are the following changes: (a) a growth of the cells lining the capsules, such as to form a mass that compresses the tuft, "and leading, finally, to obliter ation of the vessels and fibroid glome ruli"; (b) a growth of the connective tissue parallel to, and surrounding, one or more arteries having thickened walls, and forming more or less numerous and regular strips or wedges in the cortex. The new tissue between the tubules is, in the more intensely acute cases, largely cellular; in those of a subacute type it is relatively dense and fibrous.
Pleural, pericardial, and peritoneal dropsy, as well as anasarca, are also found in those dying of acute Bright's disease. Meningitis, cerebral oedema, and lobar pneumonia are also sometimes seen post-mortem.
Diagnosis. — Acute Bright's disease can hardly be overlooked when the urine is carefully examined chemically and microscopically. The eclampsia of pregnancy can, however, be recognized only by repeated examination of the urine, especially during the last months of pregnancy.
Case of subacute nephritis subsequent to an attack of simple herpetic tonsillitis. On the fifteenth day an eclamptic crisis suddenly set in, accompanied with anuria. Urine contained 1 '/, drachms of albumin per quart. The crisis became more frequent, coma set in, and the patient died with broncho-pneumonia. Histological examination of the kidneys showed, on the tubular epithelia, an im mediate lesion with cloudy tumefaction and coagulation necrosis. Siraud (Revue Inter. de Bibliographie, Apr. 25, '94).
Three cases of acute interstitial ne phritis. The first was a case of general streptococcie infection after abortion; the second also followed abortion, but the kidneys were sterile; the third was due to streptococcic infection and oc curred with broncho-pneumonia second ary to otitis media. Councilman in 1S9S reported 42 cases, in which he found Unna's plasma-cells to be the most numerous cells of the renal exudate, lymphocytes and polynuclear leucocvtes being also present in variable numbers. In the three eases plasma-cells and lymphocytes were present, but in each case there was, in addition, the eosino philie leucocyte, a cell not hitherto de scribed in nephritic exudations. W. T.
Howard, Jr. (Amer. Jour. Med. Sei., Feb., 1901).
Acute Bright's disease should be sus pected, and the urine examined, in every case showing pallor of the skin and puffy eyelids, whether general prostration of the health is apparent or not. The char acteristic symptoms of acute exudative nephritis, as commonly seen when the condition is due to cold or occurs in scarlet fever, are the following: Head ache, restlessness, muscular twitching, nausea and vomiting, a tense pulse, moderate fever, dropsy, and anaemia. Tube-casts and albuminuria are constant. It should be borne in mind that slight albuminuria occurring in the course of pregnancy or during any of the fevers, without casts, is not a true nephritis, although the latter may be a more or less remote consequence of the glandular de generation of the renal epithelium asso ciated with the febrile albumiuuria. In addition to the presence of albumin and hyaline and cell- casts, however, a minished quantity of sooty-looking urine and the discovery of red and white blood-corpuscles will render the diagno sis positive. The history of the case and the causal factors are also to be taken into consideration.
Prognosis. — A case of ordinary exu dative nephritis following exposure to cold and wet runs a course varying from a few days to three or more weeks. There is a steady diminution of the albuminuria, which finally disappears together with the casts, while the daily quantity of lighter urine and the daily excretion of urea increase. The char acter and intensity of the renal inflam: mation, and the primary disease or caus ative conditions largely determine the prognosis. Scarlatinal nephritis gives much less hope of recovery than does nephritis due to exposure to cold after alcoholic excesses. Recovery usually takes place easily after the acute paren chymatous degeneration that accom panies diphtheria, typhoid, and other infectious fevers, as well as pregnancy. In acute yellow atrophy, however, and in yellow fever, cholera, severe phos phoric or mercurial poisoning, death may occur from the intense and wide spread necrosis of renal epithelium. The dropsy and albuminuria gradually dimin ish in favorable cases of ordinary exu dative nephritis, while the color of the skin and the quantity of urine and urea increase; so that recovery is established in from three to six weeks. The albu min may persist for some time after the disappearance of the dropsy, and then gradually disappear; rarely, however, in unfavorable cases, albuminuria may con tinue and the affection become chronic parenchymatous nephritis, even after the dropsy has disappeared.