Case in which the urine was markedly foetid: much pain was experienced dur ing urination and in the interval. Six grain (0.40 gramme) doses of urotropin relieved the pain and cleared up the urine. The odor disappeared and the pus also. and in a few weeks the patient was free from severe paroxysmal attacks of cystic colic. In another case a chronic cystitis was accompanied by an ulcera tion at the base of the neck of the blad der. Notwithstanding free curetting of the ulcerated area, improvement did not follow until after the administration of urotropin. J. P. Simpson (Therapist, vol. vii. p. SI. 1901).
Amyloid, Lardaceous, or Waxy Kid. ney.
It is an open question whether this condition should be considered sepa rately, since it is but a local manifestation of a wide-spread process due to various causes: syphilis, tuberculosis, etc. It also appears as the manifestation of the de generative process of advanced Bright's disease, especially in the form following low fevers. It has already been alluded to in the article OR BRIGHT'S DISEASE (volume 1).
Symptoms.—The condition itself may not present distinct clinical features. There is usually found a history of long continued suppuration, or of syphilis; perhaps of alcohol. The urine gives gen erally very fairly characteristic indica tions. Its quantity is increased, its spe cific gravity is somewhat, but not greatly, diminished, varying from 1015 down to 1005. It is usually singularly clear and translucent, and on standing yields very little sediment. Under the microscope may be found a few casts which are gen erally hyaline. Albumin is present in large quantity. In later stages, when degeneration has set in, the urine be comes reduced in quantity, is mostly turbid, and then presents under the mi croscope the morphological signs belong ing to the degenerative process. There are associated with this condition of urine anmmia, debility, but not often much dropsy, with the characteristic transpar ent and delicate complexion. There is usually degeneration of blood; often diar rhoea and vomiting. Cerebral symptoms are not at all common. The arteries are
usually soft, and the heart generally shows very little change. Death comes by wasting, cliarrhcea, inflammation, and the kindred affections of the liver and other organs. (W. M. Ord.) Diagnosis.—The diagnosis cannot usu ally be made from the urinary examina tions alone. But if following syphilis, tuberculosis, or chronic bone-suppura tion, the urine is found to be albuminous, of low specific gravity, and increased in quantity, and the liver and spleen are enlarged, the diagnosis of amyloid dis ease may be made with comparative cer tainty.
Etiology.—Amyloid kidney is usually associated with amyloid degeneration in other organs, as the liver and spleen, and is the result of wasting diseases, tu berculosis of the lungs or intestines, syph ilis especially tertiary, chronic bone-sup puration, or other prolonged suppurative processes. It may sometimes be a sequel of gout or chronic valvular insufficiency.
Experiments with turpentine in the case of three dogs, by which waxy changes were produced in all, the spleen being most extensively affected. Czerny (Centralb. f allge. Path., Apr. 15, '96).
Pathology. — Macroscopical examina tion shows the kidney to be firm, large, smooth, and pale, except where the stel late veins arc prominent. The capsule is easily detached. Upon section the cor tex is seen to be wider than normal and pale, while the pyramids are deep red. The Malpighian tufts, which are the parts most affected by the waxy change, are translucent. Accompanying this de generation is a diffuse nephritis,—with fatty degeneration affecting the epithe lium of the tubes especially,—glomeru litis, and thickening of Bowman's cap sules.
Prognosis.—This depends, to a great extent, upon the disease which is the cause of the amyloid condition, but is usually very grave.
Treatment.—The original disease is to be treated according to indications, while the kidney trouble will be best met by the remedies and general dietetic and hygienic measures used in chronic Bright's disease (q. v., volume i).