In the treatment of all kidney diseases (or in cases where it is suspected that such a disease may he present), an examination of the urine is absolutely necessary. A microscopical examination of the urine and an interpretation of the findings should be undertaken only by a scientifically trained physician, as it is possible to do this only upon the basis of an accurate knowledge of the conditions of the urinary secretions in health and in disease. If a correct diagnosis of an affection of the kidneys has in this manner been made by a medical practitioner, it is necessary, above all, to care for the affected organs. This not only requires bodily and mental rest, but also a careful regulation of the diet. In addition to the directions given by the physician in each individual case, a warm bath (86° to 96° F.) may be taken every half-hour or hour, with subsequent wrapping of the entire body in woollen blankets. Such baths stimulate and facilitate the excretion of the water detained by the diseased kidneys, as well as of the dissolved urinary constituents. In recent cases of chronic Bright's disease a prolonged sojourn in a warm climate, with absolute rest and a careful diet, is often followed by remarkably good results.
Cancer of the Kidneys.—This affection occurs most frequently in individuals well advanced in years, although it may occur also in middle aged persons. The first manifestation of the disease may consist only of pains in the region of the loins. These are later followed by the development of a painful, immovable tumour, which can be felt through the abdominal wall, and NO) ic h may even bulge out in the lateral part of the abdomen. The pressure of this tumour may cause pain located in the abdominal wall, and this pain may radiate forward into the genital organs or into the thighs. This symptom is not infrequently accompanied with the excretion of urine containing blood. The general health of the patient also suffers from the growth of this malignant tumour. Pallor of the skin and of the mucous membranes, loss of appetite, emaciation, and decline of strength characterise the pernicious effects of renal cancer in an advanced stage of the disease. The patient's life can be saved only by operation, which must be performed after an early recognition of the affection.
Congestion of the Kidneys.—Engorgement, or congestion, of the kidneys may occur temporarily after a cold bath, drenching, bodily over-exertion, forced marching, etc. ; or it may be a permanent condition as a symptom of certain disturbances of the circulation in affections of the heart-muscle or of its valves, in severe cases of calcification of the veins or arteries, or in certain lung-affections. When it occurs as a symptom of circulatory dis
turbances, severe manifestations are usually present. There may be slight bluish discoloration of the face, congestion of the lungs (resulting in shortness of breath, and in violent cough with the discharge of whitish-red sputum), swelling of the liver, • and swollen feet and hands. In these affections the blood is congested in the kidneys, causing an impairment of their urine-secreting functions, and, as a result of this, the discharge of urine is but scanty. The urine is usually dark red and thick ; and, upon standing, it may form a conspicuous brick-red sediment. It should, however, be remembered that all urines, even that of an absolutely healthy individual, will show a brickdust deposit upon standing for any length of time in a cold room. Usually the urine contains small quantities of albumin, rarely of blood.
These secondary congestions require treatment of the underlying disease. Primary congestions due to exposure or cold, or to the effects of irritating poisons (chloroform, ether, phosphorus, etc.), should be treated Nvith great care. Rest in bed, warm applications to the loins, and a restricted liquid diet are the essentials.
Contraction of the Kidneys.—This affection is characterised by its exceedingly slow and chronic course, and by the excretion of large quantities of light, slightly albuminous, and somewhat cloudy urine. As much as three to four quarts may be passed in one day. Dropsy is usually entirely absent ; but the condition may frequently be accompanied by uriemia and by all the other disturbances described under chronic Brighl's Disease. Cerebral haemorrhages are not rare in connection with contracted kidneys. Among the causes which give rise to the affection may be mentioned calcification of veins and arteries, gout, lead-poisoning, and syphilis.
Dropsy of the Kidneys (Hydronephrosis).—An affection which occurs principally in Ivomen, and which may involve either of the kidneys. It is characterised by an accumulation of urine above the point of an obstruction brought about by an impediment in the ureter or in the bladder, thereby leading to a dilatation of the affected part, and, finally, to a pouch-like dis tention of the pelvis of the kidney. Large tumours may develop in this manner, often containing several quarts of urine. The damming of the urine, and the consequent pressure upon the kidney, may eventually lead to an impairment of the secreting functions of the organ ; in some cases it may even lead to degeneration, or to complete wasting, of the kidney-tissue.