A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
The albuminuria succeeding the collapse of Asiatic cholera or yellow
fever seems to have a somewhat similar origin, being the result of
re-establishment of the circulation after extreme anæmia of the kidney.
Clinical facts in general seem to point to simple disturbance of the
circulation and to alterations in the kidneys themselves as the usual
causes of albuminuria, though in many cases the lesion seems to be a
slight and temporary one.
Some other conditions under which such disturbances and alterations may
arise, exclusive of Bright's disease, are the following:
Munn[15] found albumen in small quantities in 11 per cent. of cases
presenting themselves for life insurance, supposing themselves healthy
and having no lesions of heart or lungs. It is not stated whether casts
were found in these cases or not, and their value as representing
healthy {39} persons cannot, it is obvious, be correctly estimated
until some time has elapsed. It is well known that renal lesions may be
exceedingly slow in their progress, and it is by no means improbable
that a part of these cases may have been really in the early stages of
a chronic form of Bright's disease. Albumen has been found in the urine
of boys and adolescents, as well as in that of healthy soldiers, tested
immediately after rising: in most of these cases the amount was
extremely small. Certain conditions, moreover, may greatly increase the
proportion of cases in these same classes in which albumen is present.
Thus, fatiguing exercise will bring it on in some persons, and the
urine of a body of soldiers if examined late in the day after severe
drill shows a much larger proportion of albuminurics than if examined
after rising. The urine of the pedestrian Weston is said to have
contained not only albumen, but casts. It is certainly not true that
fatiguing exercise will cause albuminuria in everybody, and it is not
claimed, even by those who report these and similar cases, that they
prove albumen to be a normal constituent. Some of the cases are
distinctly described as delicate without being actually ill. Cases have
been reported where cold bathing has been followed by temporary
albuminuria. Here it is in the highest degree probable that a
disturbance in the circulation is produced by contraction of the
cutaneous arterioles; and it is possible that we may find in this
increased sensitiveness of certain persons an explanation of the
occurrence of acute dropsy as a sequel to scarlatina or as the result
of exposure in only a small proportion of the cases where the exposure
takes place. It is hardly necessary to admit, on the basis of these
observations, that albumen is a constituent of healthy urine, although
this may be shown at some future day by still more delicate tests, but
simply that the renal circulation may in certain sensitive persons be
sufficiently influenced by slight and transient causes to permit
albumen to pass into the urine. It is the almost unanimous conclusion
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