In the literature of the past epidemics general acknowledgment has been accorded to the presence of albumin in the urine during the acute stage of the disease. Many times this has received no further notice or comment than “febrile albuminuria.” The association of occasional hyaline and granular casts has also been mentioned. One is impressed with the fact that the older observers laid but little emphasis on the urinary findings. It also seems to be true that nephritis as a clinical entity is not prone to follow the epidemics. In general, our conclusions from the last epidemic are about the same.
The data for this paper was obtained from examination of 994 specimens of urine from 750 patients; of this number 517 specimens were examined at the Magee Hospital, where members of the S. A. T. C., all young men, were treated, and 447 specimens from the Mercy Hospital, where, in addition to the S. A. T. C., we had men, women and children. On account of the large amount of material and work on hand, as a rule only one specimen of urine was examined from each patient, but where complications were suspected repeated daily examinations were made. We have grouped our results in tables, so that the various points may be more readily followed.
Table I shows the urinary findings of uncomplicated influenza cases admitted to the wards of the Mercy Hospital. None of these cases developed pneumonia and, after running the usual course, recovered. We would call attention to the fact that 25 per cent. showed albuminuria. The amount of albumin was never excessive, and very often was little more than a faint trace. On the other hand, we have had a few patients where a previous kidney lesion was known to be present, and naturally in these cases a heavy cloud of albumin was met with. The albuminuria was almost always a transient affair, lasting only during the acute part of the illness, and would rightly come under the class of febrile albuminuria. We regard it as being more the evidence of nephrosis than a nephritis. As a rule, the time for the appearance of albumin was after the fever had been present for at least two or three days. One rarely met with it in the short attacks of influenza where the temperature came to normal in less than 72 hours. A certain time factor appeared to be necessary in order for the nephrosis to develop. Another point of interest is the presence of red and white blood cells seen relatively frequently during the early days of the illness. One wonders if this finding is analogous to the bleeding from the nose and lung so often met with at the onset of the disease. The red blood cells were seen microscopically, and only very rarely did we encounter a smoky urine.
TABLE I
URINE ANALYSIS IN CASES OF UNCOMPLICATED INFLUENZA AT THE MERCY HOSPITAL
| Day of Disease | Total No. of Specimens | Specific Gravity | Alb. | R.B.C. | Casts | |||
|---|---|---|---|---|---|---|---|---|
| 1001–10 | 1011–20 | 1021–30 | 1031–40 | |||||
| 2 | 118 | 8 | 31 | 61 | 18 | 29 | 17 | 8 |
| 3 | 97 | 8 | 15 | 62 | 12 | 23 | 10 | 11 |
| 4 | 51 | 9 | 22 | 17 | 3 | 11 | 7 | |
| 5 | 24 | 4 | 2 | 14 | 4 | 5 | 3 | 4 |
| 6 | 11 | 8 | 3 | 4 | ||||
| 7 | 25 | 10 | 14 | 1 | 8 | |||
| 8 | 12 | 2 | 8 | 2 | 6 | 3 | ||
| 9 | 4 | 2 | 1 | 1 | 2 | |||
| 18 | 2 | 1 | 1 | |||||
| Totals | 344 | 29 | 95 | 186 | 44 | 88 | 37 | 26 |
TABLE II
URINE ANALYSIS IN CASES OF UNCOMPLICATED INFLUENZA AT THE MAGEE HOSPITAL
| Day of Disease | Total No. of Specimens | Specific Gravity | Alb. | R.B.C. | Casts | |||
|---|---|---|---|---|---|---|---|---|
| 1001–10 | 1011–20 | 1021–30 | 1031–40 | |||||
| 1 | 101 | 6 | 22 | 49 | 24 | 5 | 3 | |
| 2 | 127 | 1 | 17 | 75 | 34 | 13 | 3 | |
| 3 | 82 | 3 | 13 | 55 | 11 | 13 | 1 | 4 |
| 4 | 36 | 1 | 14 | 18 | 3 | 4 | 2 | |
| 5 | 40 | 2 | 9 | 24 | 5 | 6 | 1 | 2 |
| 6 | 23 | 1 | 5 | 15 | 2 | 7 | 1 | 3 |
| 7 | 5 | 1 | 4 | 3 | 2 | |||
| 8 | 5 | 1 | 4 | |||||
| 9 | 2 | 1 | 1 | |||||
| 10 | 10 | 1 | 3 | 5 | 1 | 2 | 1 | |
| 11 | 3 | 3 | 2 | 1 | ||||
| 12 | 3 | 1 | 2 | 2 | 1 | |||
| 13 | 1 | 1 | 3 | |||||
| 14 | 1 | 1 | ||||||
| 15 | 5 | 1 | 4 | |||||
| Totals | 447 | 17 | 87 | 263 | 80 | 57 | 4 | 21 |
The results shown in Table II illustrate the urinary findings at the Magee Hospital, and, as in the previous table, include cases of influenza which did not develop pneumonia. The specimens examined were obtained from young, healthy men, between the ages of 20 and 32, and showed albumin in 13 per cent. of the cases. This age factor probably accounts for the lower incidence of albuminuria for this group.