OXALURIA.
Definition.—Although, logically, the term oxaluria ought to be limited to an abnormal condition of the urine terized by the presence of an increased amount of oxalic acid, ordinarily it is employed to signify the precipitation of a sediment of oxalate of lime by the urine, caused commonly by diminution of the acid phosphates and compatible even with very small percentages of oxalic acid in the urine.
Normally about 0.02 gramme of oxalic acid is excreted daily, but, as the oxalic acid contained in the aliments easily passes in the urine, that amount may easily be increased by the ingestion of sorrel, spinach, etc. The crystals of ox alate of lime are pellucid octceders, solu ble in muriatic acid, but not in acetic acid.
Etiology and Pathology.—The forma tion of a sediment of oxalate being held by many authors to be the result of ab normal metabolism, it was believed to be intimately connected with many symp toms of disease, especially of the nervous system. Prout, Golding-Bird, and Can tani mentioned as the symptoms of ox aluria general weakness, restlessness, headache, pain in the spine and in the abdomen, painful micturition, dimin ished sexual power, hypochondria, mel ancholia, etc. Later investigations have proved that the precipitation of oxalate may be compatible with perfect health, although it is often observed in disorders of the nervous system, of which it can, nevertheless, not be considered to be the cause. The only danger arising from the sedimentation of oxalate is that it may give rise to a calculus, and sometimes the presence of minute calculi will reveal it self by painful micturition.
From a study of cases of oxaluria fol lowing deductions are made: 1. Whereas the appearance of oxalates in the urine —excluding their ingestion in foods—is due to a derangement of digestion or metabolism, this derangement probably has its cause in many cases in functional nervous irregularity, which may or may not be so great as to produce general nervous symptoms; and, if these are present, they are not necessarily caused by the oxalate-. 2. The condition caus ing. the appearance of oxalates in the urine may produce symptoms closely the constitutional symptoms of Bright's disease. 3. The excretion of cxalates by the kidney for a short while may occasion no local disturbance of that organ, but if continued may. by irritation, cause the appearance of albu min and casts with lessened urine, cor responding Lo the urinary symptoms of Bright's disease, and if unchecked, may lead to permanent destruction of kidney tissue and to true Bright's disease. 4. In all suspicious cases in which the nephritic symptoms are accompanied by the appearance of oxalates in quantity, diagnosis should be held in abeyance and the oxaluria be overcome by appropriate remedies to exclude this as a possible cause of the symptoms before making a positive diagnosis and pronouncing, a necessarily hope - dispelling prognosis.
E. F. Williams (Med. Register, Apr. 15, '99).
One hundred quantitative estimations of the amount of oxalic acid in the urine and feces of various individuals. Con clusions that oxalic acid found in human urine is derived to a very small extent, if at all, from oxalates ingested. The greater quantity arises in the organism, and, when the excretion is increased after taking large quantities of oxalates, the amount represents but a small por tion of that ingested. There is no rela tion between the oxalates excreted and the decomposition of albumin, but food rich in nuelein causes a distinct increase, as does also food rich in gelatin-sub stances. Loraine] (Deutsches Archly f. klin. Med.. Aug. IS, '991.
The significance of oxaluria depends upon whether it appears in concentrated urine or in urine of low specific gravity. In the former instance its presence is probably due to decomposition of the orates, and consequently is of little sig nificance. whereas in the latter, espe cially if the deposit is constantly pres ent. it indicates a morbid defect.
The causes of oxaluria are not thor oughly understood. It may be readily induced by partaking of certain articles of food, such gooseberries, tomatoes, or rhubarb, and some authorities even hold that oxaluria depends always upon the existence of oxalates in the diet. According to Bence-Jones, oxalnria is due to incomplete oxidation of the carbohydrate proximate principles of food. Hence the increased excretion of oxalate of lime in dyspeptic and nervous troubles and in cases of glycosuria. The circumstance is recognized that oxaluria may persist in certain individuals, even when all articles of diet known to con tain oxalic acid or its compounds in any form are avoided, whereas in other per sons, even though they partake freely of diet known to be rich in oxalic acid, we fail to find any evidence of oxaluria. David _Newman ((ilasgow Med. Jour., Oct., 1001).
treatment consists in the prohibition of such aliments as contain large quantities of oxalic acid (sorrel, spinach, rhubarb), in recom mending a proper diet containing a fair portion of meat and thus augmenting the acidity of the urine, and in prescrib ing alkaline spring-waters in moderate doses in order to saturate the excessive acidity of the gastric juice often corre sponding to a diminished acidity of the urine, and to dilute the urine and dis solve the salts contained in it.