Uratic Deposits in Nephritis
Here, again, we light upon another point of contact between gout and nephritis, for an interesting feature of the latter disorder is that the retained uric acid, purins, and other excretory products are deposited in cartilage and serous membranes. At these sites they are frequently detected post mortem, though they fail of ante-mortem recognition.
Impressed by the fact that, at post-mortems, uratic incrustation of the articular cartilages was frequently observed in persons who had never suffered from overt gout, Ord and Greenfield sought to ascertain the frequency with which such uratic deposits were associated with renal disease. Out of ninety-six cases presenting renal lesions, no less than eighteen exhibited uratic deposits in the joints.
A still more elaborate research in this sphere was undertaken by Norman Moore. Out of forty-nine cases of chronic interstitial nephritis, uratic deposits were present in twenty-two instances. Again, out of nine cases of chronic parenchymatous nephritis, deposits were found in the joints in two cases. With respect to the first group he observes that “chronic interstitial nephritis is not invariably accompanied by deposits in the articular cartilages, though usually accompanied by traces of degeneration in some of the articular cartilages.”
Levison, too, an ardent supporter of the primary renal origin of gout, noted that all the subjects dying at the Communal Hospital, Copenhagen, of granular kidney disease (during a period of fourteen months) exhibited uratic deposits in one or other of their joints, although they were never known to have had any definite attack of gout.
Luff, in the following table, shows the results of the examination of the joints in seventy-seven cases of granular kidney disease.
| No. of cases. | Uratic deposits in joint or joints. | |
|---|---|---|
| Known to have had gout | 10 | 10 |
| Never known to have had gout | 67 | 31 |
| Totals | 77 | 41 |
Of the ten cases known to have suffered from gout, the renal condition was in every instance defined as “markedly granular,” or “fairly granular.” Uratic deposits were invariably present in one or more joints. Of the sixty-seven examples not known to have had gout, uratic articular deposits were found in 46 per cent., which approximates, more or less closely, to Norman Moore’s findings. It is noteworthy that in several of the instances, lacking uratic deposits in the joints, the kidneys were described as “slightly granular,” or “faintly granular.”
| No. of cases. | Uratic deposits in joint or joints. | |
|---|---|---|
| Marked granular kidney disease | 26 | 20 |
If of the sixty-seven cases there be selected only those described as “markedly granular,” or “typical granular kidneys,” the incidence of uratic deposits in the joints, as revealed by the second table, reaches no less a figure than 77 per cent.
Another authority, discussing the frequency of incidence of uratic deposits in the joints in cases of chronic interstitial nephritis, states that, at post-mortem, from 50-80 per cent. show their presence—this, moreover, in cases known not to have had gout.