Chronic Brights Disease

kidney, child, albuminuria, kidneys, casts, condition, symptoms and passed

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The above case represents a form of derangement which is sometimes met with in the infant. It is not an ordinary case of gastric catarrh, such as is common in early infancy, for in this disorder the elasticity of the skin is in no way interfered with. Nausea and vomiting, constipation, a dry, inelastic skin, and slight albuminuria, form a combination of symptoms constantly met with in cases of deficient renal secretion in children whose water can be tested, and also in adults, according to Sir Andrew Clark. It seems, therefore, at any rate possible that diminished functional activity of the kidneys may produce similar symptoms in the infant. Kjellberg has observed a frequent connection between intestinal catarrh and parenchy matous inflammation of the kidney in the young child, and mentions as one of the characteristic symptoms of the kidney complication a dry, tough skin without elasticity. In every case, therefore, where we find this condition of the skin in a young subject, we should examine very carefully for signs of renal disease.

Diagnosis.—In examining for albumen a specimen of the urine passed after the first meal in the day should be taken, and the fluid should be afterwards set aside in a conical glass in order that solid particles, if any, may subside. The deposit should be taken up carefully with a pipette, and placed in a shallow cell made by cementing a thin ring of glass on to the ordinary microscope slide. This, covered with a thin glass, should be carefully searched for casts of tubes.

The complete absence of albmninuria and casts is no sufficient indica tion that the kidneys are perfectly healthy. It seems probable, from the cases which have been narrated, that a certain amount of disease may exist in the kidneys although the urine presents the characters of health ; and it is now an established fact that considerable a.myloid degeneration may exist in the organ without its presence by any abnormal condition of the urinary secretion. In all cases where renal disease is suspected, although no albuminuria can be discovered, it is well to cause the whole amount of water passed in the twenty-four hours to be collected. A calculation can then be made from the specific gravity of the fluid, by means of Professor Haughton's tables,' which will give a rough estimate of the quantity of urea being excreted in the course of the day and night. If at the same time we ascertain the weight of the child, the amount of solid matters passed for each pound of his weight can be easily calculated. A healthy child should pass daily between five and six grains of urea per pound of his weight.

If albuminuria and casts can be detected, it is not always easy to decide upon the nature of the kidney lesion. The presence of amyloid degeneration of the liver and spleen renders the same condition of the kidney very probable. A chronic form of Bright's disease succeeding to an acute attack, such as an attack of scarlatinous nephritis, is usually clue to the fatty kidney (chronic parenchymatous nephritis) ; but this form of Bright's disease may also, like the contracted granular kidney, begin. in sidiously. If albuminuria and casts are present without dropsy, the kidney is probably granular.

The constant passage of red sand from the kidneys is to be regarded with anxiety, for in such cases Bright's disease may be developed after a time, as in the case of the child before referred to.

Prognosis.—When Bright's disease is established in the child, i.e., when albumen and casts are constantly present, UK. prognosis is very un favourable ; for such a condition, if it do not destroy life unassisted, must greatly increase the danger of any intercurrent malady. Such children, if attacked by pneumonia or pleurisy, are very likely to die. In the case of amyloid kidney the prognosis is, perhaps, less unfavourable than in the other forms of Bright's disease ; for it seems possible that, if the chronic suppurative process which has excited the structural change can be re moved by operation or otherwise, all the symptoms of kidney derangement may disappear. That such a happy termination to the illness is possible, is proved by a case published by Mr. Barwell, in which, after the removal of a scrofulous joint, albuminuria and casts ceased after a time to be found in the urine, and the child grew up into a strong, healthy woman. From this case we may learn that the existence of amyloid disease of the kidneys is no bar to the successful issue of operative procedures ; but that on the contrary, surgical interference in such cases is urgently called for.

Mere renal inadequacy, without albuminuria or history of acute Bright's disease, is probably in most cases a merely temporary condition which, under suitable treatment, may be rapidly recovered from. But if a child habitually pass large quantities of uric acid sand, or if he have more than one attack of acute Bright's disease, even although the urine have been normal in the interval, and return to a healthy state after the symptoms have passed away, we should regard the possibility of his ultimately devel oping manifest disease of the kidneys as one not to be entirely excluded from consideration.

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