ORTHOTIC ALBUMINURIA (Houbner).
(Synonym: Cyclic Alliuminuria, Payy) Orthotic albuminuria is that form of albumin excretion which occurs in an affected person on assuming the upright position and is dependent on the change in posture.
From the time that Pavy, Bull and von Noorden published their first observations on this affection, the literature has attained consider able dimensions, Germany being comparatively late in following the advances of the English and French profession.
The affection preponderates in the period from infancy to puberty. Children whose night urine is free from albumin, excrete albumin in the course of the day. It disappears completely in prolonged decubitus and reappears immediately as soon as the upright position is assumed. Thus there are no external causes responsible for this condition, but the external factor of changing the horizontal for the vertical position. It is associated with t,he ordinary' conditions of life and manifests itself in the fact that the albuminous content of the urine occurs and increases during the clay and that it decreases or disappears at night. Continued erect position therefore gradually loses its specific significance, since the cy-cle can be influenced at will. Heubner's term "orthotie" is therefore preferable to Pavy's designation "cyclic." It was Sterling who, in 1S87, first recognized that the erect position occasioned albuminuria and for this reason he termed it "postural albuminuria." Teissier selected the term "Albuminurie de la station debout," or "albilininurie orthostatique." The reason why Heubner employed "orthotic" instead of "orthostatic" is that the latter term merely expresses the act of assuming the erect position.
Albuminous Excretion in a Qualitative and Quantitative Respect.— Nearly all authors who have investigated the chemical nature of the albumin excreted in orthotic albuminuria, notably von Leube, Dresser, Keller, Oswald, Rostoski and Cloetta, have been struck by the fact that the albuminous substance which was present either alone or together with others, could be precipitated by acetic acid. This fact has revealed interesting relations between orthotic alburainuria and that form of albumin excretion which von Leube observed in his wholesale examina tions of soldiers after drill. He found that if the drill was light, there was
nucleo-albumin in pre \ iously non-albuminous urine, while after strenu ous service there was also sero-aibumin.
In a large number of quantitative examinations in orthotic albumi nuria I have found three types of cases: (1) in which none but the albu minous, body is excreted which is precipitable by acetic acid and which is generally associated with slight albuminuria; (2) in which not only the albuminous body, precipitable by acetic acid, is excreted, but also true proteid, the quantity of which may arnount to more or to less than that of the former; (3) in which all three kinds of albuminous substances —the one precipitated by acetic acid, albumin and globulin—are excreted in varying proportions. This division requires only some limitation in the sense that cases in which one or two kinds are evacuated have been but rarely observed, and if I refer to their 'occurrence at all, it is merely to say that more than one proteid substance were present in quanti tatively undeterminable traces.
The proportion of the substance precipitable by acetic acid to the total quantity of excreted albumin was about 30 to 100 in twelve cases, 90 to 100 in the great majority, and from 7 to 16 in a minority of seven eases. In 78 per cent. of all cases the quantity precipitated by acetic acid exceeded that of pseudoglobulin, and in 22 per cent. it amounted to less.
These results are not only of value for healthy persons after exercise, but also, and even in a higher degree, when compared with those forms of albuminuria which are symptoms of acute or chronic nephritis. In this connection it is of importance to note that among the chronic renal diseases, which alone can give rise to a differential diagnosis with ortho tic alburninuria, amyloid kidney is the only one which is accompanied by the excretion of large quantities of albuminous bodies precipitable by acetic acid, while only small quantities, if any at all, are present in so-called chronic nephritis of both adults anci children.