TUBERCULOSIS OF THE KIDNEYS In this place we shall discuss only those cases of renal tuberculosis which are distinguished by special local symptoms. They are in a minority, because the symptoms which proceed from the kidneys are as a rule masked by those of the general tuberculosis. If we discover the existence of tuberculosis in ono or more organ, and associated with it we find albuminuria and casts it may be impossible to decide whether we have to deal with a nephritis complicating tuberculosis, or with a case of tuberculosis of the kidneys.
Renal tuberculosis is characterized by general and local symptoms, and by changes in the quantity and quality of the urine. The children have fever, become emaciated, and palpation reveals enlargement of the kidney, or even where the examiner is particularly skilful, the pres ence of tumors in the renal tissues. Pain in the kidney or tenderness to pressure are present. The former is especially apt to be found where
there is perinephritic involvement, which is attended generally by spastic rigidity of the psoas muscle. The only symptoms of renal tuberculosis in younger children are incontinence and dysuria. The urine often con tains great quantities of albumin, casts, pus corpuscles, especially lym phocytes, and blood. If the ureter is occluded there will be no changes found in the urine. The finding of Koch's bacillus of tuberculosis in the urine renders the diagnosis positive. If the disease is restricted to one kidney, a surgical operation may effect a cure. Ureteral catheterization, and examination of the condition of the urine from the other kidney is here of the first importance to decide whether an operation is proper or not.