NEPHRITIS The nephritis is usually ushered in with vomiting, loss of appetite and rise in temperature. The face is pale, and sometimes the first symp tom manifested is a characteristic puffiness of the eyelids.
So far as the kidney itself is concerned, there is at first found a trace of albumin in the urine; in the course of two or three days the urine contains blood and is rich in sediment. Then, again, the nephritis is ushered in with Inematuria, as in the following case, when other severe initial symptoms (Iymphadenitis, high fever) direct attention to the condition.
Herminie M., aged four years. Moderately severe attack of scarlet fever, with fever until the sixteenth day caused by a complicating syno vitis and otitis. On the twentieth and twenty-first clays, fresh joint pains; then no temperature elevation until the thirtieth day. At four o'clock in the afternoon, 37.1° C. (98.6° F.); patient cheerful. At six o'clock, the patient complains of pain in the region of the angle of the jaw on the right side; inside of four hours the temperature rises to 40.9° C. (105.S° F.); pulse, 200. The following morning, temperature, 3S.4° C. (101° F.); at the angle of the jaw on the right side, a painful lymph-node, size of a bean, surrounded by a diffuse swelling.
In the morning of the thirty-second day, temperature, 37.S° C. (99° F.); morning urine free of albumin; temperature at noon, 40.4° C. (104° F.). At 2 r.m., sudden luematuria (not much blood). Frequent vomiting; appearance of a fleeting eruption, consisting of large macules. Urine contains much sediment. Intermitting temperature of .high degree continues until the thirty-fifth day. Blood disappears from the urine on the thirty-seventh day; albumin disappears on the forty-sixth day maximum amount of albumin on the thirty-third day, 4- per cent.). Complete recovery.
In cases where the hwmaturia is the initial symptom, it is so evident that it is hardly possible to overlook the kidney complication. Even in the case of small children, who are apt to void the urine on the bed ding, the presence of blood is shown by the brownish spots on the bed linen.
The urine may be cloudy, bright red, brownish-red and deposits a considerable sedinwnt. The brownish-red color does not by any means indicate a nephritis of severe grade; in fact, the urine may be of this color from the beginning of the trouble. The ment consists of all kinds of casts, fresh and disintegrated red puscles.
Chemically, the urine contains albumin in quantities of from one-quarter to ten per cent., seldom more than this. It is important to examine the urine (heat, acetic acid and potas sium ferrocyanide tests), because often traces of albumin appear in the urine just before the onset of the lnematuria, and, in some instances, the albuminuria is the only symptom in mild grades of nephritis.
Another symptom is a diminished quantity of urine. Unless there is also a Inematuria, this diininution is apparent only when it is extreme. Whenever traces of albumin are detected, the twenty-four-hour speci men should be collected and the amount carefully measured. From the prognostic standpoint, this is of the greatest importance.
Of equal significance is the daily record of the body weight, although in private practice this is not often possible. Variations in body weight are indicative of a rise and fall in the grade of (edema, which so often is a symptom in nephritis. This is likewise of prognostic value.
Unlike the (edema Occurring in cases of heart disease, the of nephritis may be seen not only in the dependent portions of the body (hypostatic (edema), but especially in the face (eyelids), the feet and in the scrotum. In severe grades of (edema, fluid gathers in the serous cavities (ascites and hydrothorax), and a general anasarca may result. The appearance and disappearance of the cede= often succeed rapidly on one another, as in the following typical case of a well-developed nephritis: Robert M., aged eleven years (Fig. 55). On the third clay presented an intense scarlatinal eruption, but only a slight pharyngeal inflamma tion. Inside of two days temperature fell to normal. Desquamation; general condition good until the sixteenth day.