Inflammation of the kidneys may further be a form or an extension of a specific contagious disease, such as erysipelas, rinderpest, septicemia, or even of poisoning by the spores of fungi. Rivolta reports the case of a cow with spots of local congestion and blood staining in the kidney, the affected parts being loaded with bacteria. Unfortunately he neither cultivated the bacteria nor inoculated them, and thus the case stands without positive demonstration that they were the cause of disease.
In certain cases the Symptoms of nephritis are very manifest, and in others so hidden that the existence of the affection can be certainly recognized only by a microscopic examination of the urine. In violent cases there is high fever, increase of the body temperature to 103° F. and upward; hurried breathing, with a catching inspiration; accelerated pulse; dry, hot muzzle; burning of the roots of the horns and ears; loss of appetite; suspended rumination; and indications of extreme sensitiveness in the loins. The patient stands with back arched and hind legs extended backward and outward, and passes water frequently, in driblets, of a high color and specific gravity, containing albumin and microscopic casts. ([Pl. XI], fig. 5.) When made to move, the patient does so with hesitation and groaning, especially if turned in a narrow circle; when pinched on the flank just beneath the lateral bony processes of the loins, especially on that side on which the disease predominates, it flinches and groans. If the examination is made with oiled hand introduced through the last gut (rectum), the pressure upward on the kidneys gives rise to great pain and to efforts to escape by moving away and by active contractions of the rectum for the expulsion of the hand. Sometimes there is a distinct swelling over the loins or quarter on one or both sides. In uncastrated males the testicle on the affected side is drawn up, or is alternately raised and dropped. In all there is a liability to tremors of the thigh on the side affected.
In some severe cases colicky pains are as violent as in the worst forms of indigestion and spasms of the bowels. The animal frequently shifts from one hind foot to the other, stamps, kicks at the belly, frequently looks anxiously at its flank, moans plaintively, lies down and quickly gets up again, grinds its teeth, twists its tail, and keeps the back habitually arched and rigid and the hind feet advanced under the belly. The bowels may be costive and the feces glistening with a coat of mucus, or they may be loose and irritable, and the paunch or even the bowels may become distended with gas (bloating) as the result of indigestion and fermentation. In some animals, male and female alike, the rigid, arched condition of the back will give way to such undulating movements as are sometimes seen in the act of coition.
The disease does not always appear in its full severity; for a day, or even two, however, there may be merely loss of appetite, impaired rumination, a disposition to remain lying down, yet when the patient is raised it manifests suffering by anxiously looking at the flanks, shifting or stamping of the hind feet, shaking of the tail, and attempts to urinate, which are either fruitless or lead to the discharge of a small quantity of high-colored or perhaps bloody urine.
In some recent slight cases, and in many chronic ones, these symptoms may be absent or unobserved, and an examination of the urine is necessary to reach a safe conclusion. The urine may contain blood, or it may be cloudy from contained albumin, which coagulates on heating with nitric acid (see "Albuminuria," [p. 121]); it may be slightly glairy from pus, or gritty particles may be detected in it. In seeking for casts of the uriniferous tubes, a drop may be taken with a fine tube from the bottom of the liquid after standing, and examined under a power magnifying 50 diameters. If the fine, cylindroid filaments are seen they may then be examined with a power of 200 or 250 diameters. ([Pl. XI], fig. 5.) The appearance of the casts gives some clue to the condition of the kidneys. If made up of large, rounded or slightly columnar cells, with a single nucleus in each cell (epithelial), they imply comparatively slight and recent disease of the kidney tubes, the detachment of the epithelium being like what is seen in any inflamed mucous surface. If made up largely of the small, disk-shaped and nonnucleated red blood globules, they imply escape of blood, and usually a recent injury or congestion of the kidney—it may be from sprains, blows, or the ingestion of acrid or diuretic poisons. If the casts are made of a clear, waxy, homogeneous substance (hyaline), without any admixture of opaque particles, they imply an inflammation of longer standing, in which the inflamed kidney tubules have been already stripped of their cellular (epithelial) lining. If the casts are rendered opaque by the presence of minute, spherical granular cells, like white blood globules, it betokens active suppuration of the kidney tubes. In other cases the casts are rendered opaque by entangled earthy granules (carbonate of lime), or crystals of some other urinary salts. In still other cases the casts entangle clear, refrangent globules of oil or fat, which may imply fatty degeneration of the kidneys or injury to the spinal cord. The presence of free pus giving a glairy, flocculent appearance to the urine is suggestive of inflammation of the urinary pouch at the commencement of the excretory duct (pelvis of kidney) ([Pl. IX], fig. 1), especially if complicated with gritty particles of earthy salts. This condition is known as pyelitis. In the chronic cases swelling of the legs or along the lower surface of chest or abdomen, or within these respective cavities, is a common symptom. So, also, stupor or coma, or even convulsions, may supervene from the poisonous action of urea and other waste or morbid products retained in the blood.
Treatment.—In the treatment of acute nephritis the first consideration is the removal of the cause. Acrid or diuretic plants in the feed must be removed, and what of this kind is present in the stomach or bowels may be cleared away by a moderate dose of castor or olive oil; extensive surfaces of inflammation that have been blistered by Spanish flies must be washed clean with soapsuds; sprains of the back or loins must be treated by soothing fomentations or poultices or by a fresh sheepskin with its fleshy side applied on the loins, and the patient must be kept in a narrow stall in which it can not turn even its head. The patient must be kept in a warm, dry building, so that the skin may be kept active rather than the kidneys. Warm blanketing is equally important, or even mustard poultices over the loins will be useful. Blisters of Spanish flies, turpentine, or other agent which may be absorbed and irritate the kidneys must be avoided. The active fever may be checked by 15 drops tincture of aconite every four hours or by one-third ounce of acetanilid. If pain is very acute, 1 ounce of laudanum or 2 drams of solid extract of belladonna will serve to relieve. When the severity of the disease has passed, a course of tonics (quinin, 2 drams, or gentian powder, 4 drams, daily) may be given. Diuretics, too, may be given cautiously at this advanced stage to relieve dropsy and give tone to the kidneys and general system (oil of turpentine, 2 teaspoonfuls; bicarbonate of soda, 1 teaspoonful, repeated twice a day). Pure water is essential, and it should not be given chilled; warm drinks are preferable.
In the chronic forms of kidney inflammation the same protection against cold and similar general treatment are demanded. Tonics, however, are important to improve the general health (phosphate of iron, 2 drams; powdered nux vomica, 20 grains; powdered gentian root, 4 drams, daily). In some instances the mineral acids (nitric acid, 60 drops, or nitrohydrochloric acid, 60 drops, daily) may be used with the bitters. Mustard applied to the loins in the form of a thin pulp made with water and covered for an hour with paper or other impervious envelope, or water hotter than the hand can bear, or cupping, may be resorted to as a counterirritant. In cupping, shave the loins, smear them with lard, then take a narrow-mouthed glass, expand the air within by smearing its interior with a few drops of alcohol, setting it on fire and instantly pressing the mouth of the vessel to the oiled portion of the skin. As the air within the vessel cools it contracts, tending to form a partial vacuum, and the skin, charged with blood, is strongly drawn up within it. Several of these being applied at once, a strong derivation from the affected kidneys is obtained. In no case of inflamed or irritable kidney should Spanish flies or oil of turpentine be used upon the skin.
PARASITES OF THE KIDNEY.
As the kidney is the visual channel by which the bacteria leave the system, this organ is liable to be implicated when microphytes exist in the blood, and congestions and blood extravasions are produced. In anthrax, southern cattle fever (Texas fever), and other such affections bloody urine is the consequence. Of the larger parasites attacking the kidney may be specially named the cystic form of the echinococcus tapeworm of the dog, the cystic form of the unarmed or beef tapeworm of man, the diving bladderworm—the cystic form of the marginate tapeworm of the dog, and the giant strongyle— the largest of the roundworms. These give rise to general symptoms of kidney disease, but the true source of the trouble is likely to be detected only if the heads or hooklets of the tapeworm or the eggs of the roundworm are found on microscopical examination of the urine.