CALCULUS.
Tuberculosis of the Kidney.—This malady occurs in the form of tiny miliary tubercles scattered through the kidney, usually as a part of a general tuberculosis and in the form of a tubercular pyonephrosis due to extension from the bladder ; more rarely the process may be primary in the kidney and then extend to the bladder. The symptoms are frequent micturi tion, pyuria, hematuria and occasionally the presence of a tumor. The diagnosis is difficult unless there be tuberculosis of the bladder, testes or seminal vesicles. Although the prog nosis is always grave, cases have recovered where the kidney has been inspected but not removed. Nephrectomy is not performed unless the other kidney can be proven sound.
Injuries of the Severe contu sions of the abdomen or loins may cause lacera tion of the kidney substance and the capsule, or the kidney may be perforated by stab or gunshot wounds. Slight contusions cause pain and transient hematuria, but the more severe contusions and wounds allow the urine to flow out into the surrounding tissue, sometimes with inflammation following. The wound may re quire sutures, or the kidney may have to be removed.
Suppuration in and around the Kidney.— This condition is due to the infection of the part with micro-organisms, which may reach the part in three ways— through the blood, from the bladder and through the perforating wounds. It is now commonly noticed that per sons in health may pass bacteria through their kidneys without resulting suppuration; and it seems that some injury must take place to allow them to grow there and cause actual dam age. Such damage may be made by calculi or contusions. Pylitis is an inflammation of the pelvis of the kidney and this part is first in volved when the inflammation travels up from the bladder. Pyelonephritis is an inflammation of both pelvis and kidney structure. Pyone phrosis is the name used to describe the condi tion of dilatation of the pelvis and the kidneys with pus: the organ may be entirely destroyed. Perinephritis is an inflammation of the cellular tissue and fat around the kidney. In pya-nua
there may be many small abscesses in the kid ney substance.
The symptoms of these various forms de pend on the severity and site in the inflamma tion: there are the changes n the urine (the presence of pus, blood and epithelium from the various parts), the local signs (pain and possibly swelling) and the general signs of poisoning (fever, rigors, septic look, nausea, vomiting, etc.). An abscess in the kidney may burrow through to the surface; it may drain sufficiently through the normal channels and become chronic; or the patient may die of acute sepsis.
In the treatment of the milder forms it may be sufficient to remove the cause: the bladder may be cleansed by irrigation; or if a pcnetrat ing wound be the cause it may be enlarged and cleansed. If there be a perinephritis or a se vere pyelonephritis, the abscess-cavity must be drained. The kidney is removed (nephrectomy) if destruction has gone too far.
Movable or Floating By this phrase is meant a condition in which the kid neys leave their fatty bed and travel downward or otherwise through the abdomen. In the milder grades of this condition the kidney is displaced downward during inspiration, but in the more severe grades one or both are con stantly low, even down to the pelvis. No symp toms whatever may arise from this condition; but on the other hand the dragging on the ves sels and nerves may give rise to pain in the back and sides, minor disturbances of digestion or nausea and vomiting. The nervous system is so deranged that it is common to have most confusing symptoms. Occasionally the ureter becomes twisted and dams back the urine, caus ing marked distention of the pelvis of that organ, a condition called hydronephrosis. When such an obstruction persists, the kidney struc ture is gradually thinned until its function is lost. It is customary to have the sufferer from a floating kidney wear a support around the abdomen; at times the operation of fixation of the kidney in its normal place may be advisable.