INTERMITTENT FORM (LANDAU). In this variety decided variations in the size of the tumors occur: i.e., coincident with a more or less sudden increase in the quantity of urine passed (polyuria) the tumor quickly diminishes. On the other hand, the enlargement gradually in creases from retention as the flow of urine decreases. The principal cause of hydronephrosis is a movable kidney, and hence the affection occurs mostly in women that have borne children. Ac cording to Albarran, the polyuria which commonly follows the attacks of pain in movable kidney is due to excessive uri nary secretion, and not to a flow of urine which has previously been retained in the pelvis of the kidney. He reports a number of cases in which an operation for movable kidney, in patients suffering from intermittent hydronephrosis, was performed by himself, and total absence of dilatation of the pelvis of the kidney was noted.
Preceding and accompanying the poly uria in these cases are colicky pains, and hlematuria is not uncommon. For ob vious reasons, the tumor in intermittent hydronephrosis displays considerable mo bility. The general features consist merely of a certain loss of flesh and strength incident to the associated worry and anxiety. The filling of the nephry drotic cyst, the enlargement, and the pain of subsequent discharge, with marked diminution of the tumor, recur with variable frequency. Among the
causes that are apt to produce a kinking of the ureter, and thus excite an attack, are violent physical exertion; jarring or jolting, as in riding or driving; or acute gastrointestinal derangement, and strong mental emotions. The duration of the attacks varies from several hours to a day, though the cyst may continue to increase in size for several days after the pain has disappeared. During the intervals, and even while the greatly in creased flow of urine is present, the pa tient feels tolerably comfortable.
The occurrence of chills, fevers and sweats, rapid pulse, nausea and vomiting, and abdominal distension is indicative of suppuration, and the appearance of the common sequel—pyonephrosis. This is confirmed by the cloudy urine, revealing pus, following both discharge and aspira tion. Chronic nephritis may supervene, as shown by the lower specific gravity and the presence of albumin and casts in the urine. The arterial tension will then be increased, as a rule. Among other sequelfe may be mentioned acute febrile or chronic afebrile uraemia, the latter having been mentioned above.
Differential Diagnosis. — (a) Pvone phrosis may be eliminated in the absence of an abundance of in the as pirated fluid and of the general symp toms of suppuration.