Studies on Epidemic Influenza: Comprising Clinical and Laboratory Investigations

by University of Pittsburgh. School of Medicine

TABLE III

URINE ANALYSIS IN CASES OF PNEUMONIA (INFLUENZAL) 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
1	47	4	14	25	2	36	7	6
2	22	1	8	9	4	19	1	4
3	9	2	3	3	1	7	1
4	6	1	3	2		4	1
5	6	1		5		5		1
6	16	2	7	7		13	2	7
7	9		5	3	1	8
8	3		1	2		3
9	3		2			2
10	1					1
11
12	3		2	1		2
13	4		1	3		3		1
14	2			2		2
15
16
17
18	1			1		1
19
20	1		1
Totals	133	11	47	63	8	106	13	19

Table III includes the urinary findings of patients diagnosed as influenzal pneumonia. In this table the term “Day of Disease” indicates the day on which the physical signs of pneumonia could be demonstrated, and not the day on which the patient was taken ill with influenza. The incidence of albuminuria—79 per cent.—is very high, while the presence of casts and red blood cells is low. These results are really what one would expect. As we have noticed in the late stages of uncomplicated influenza a greater tendency for urinary changes to become apparent, one would, therefore, most likely find considerable urinary disturbance in the pneumonia immediately following the epidemic disease. Pneumococcic pneumonia is prone to be accompanied by an albuminuria. So when we have both influenzal and pneumococcic etiological factors involved, it is but natural to have most of the patients showing signs of kidney disturbance. The amount of albumin present, although generally greater than in uncomplicated influenza, was not excessive. At times there was little more than a trace. We noted the relative scarcity of casts—a condition which differs greatly from our past experience in the ordinary lobar pneumococcic pneumonia. On the transient nature of this kidney involvement we have considerable positive evidence, but there is no question that the time required for the urine to return to normal is longer after pneumonia than uncomplicated influenza. We have observed but one or two cases which afterward returned to us presenting clinical signs of acute nephritis. In fact, in going over our hospital records of the winter and spring we noted that an unusually small number of acute nephritics have been admitted. This would seem to be evidence that, as has been noted in the past, the kidney is not a vulnerable organ in this epidemic disease.

TABLE IV

URINE ANALYSIS IN CASES OF PNEUMONIA (INFLUENZAL) 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	3			2	1	1		1
2	12		1	10	1	8		6
3	4			4		1	1	1
4	9	1	2	4	2	6		6
5	8		4	4		6		5
6	8		5	3		7	2	6
7	4		2	2		3		2
8	10		2	8		5	2	5
9	4		2	2		4	3	4
10	6		1	5		6	3	5
11	1		1			1		1
12	1		1			1
13
14
15	2		2			1		1
Totals	70	1	20	45	4	49	11	40

Table IV includes specimens obtained at the Magee Hospital from patients diagnosed as pneumonia. The results among these young students were very similar to those of the previous chart, where all ages were included. However, casts and red blood cells were more regularly noted.

From the four tables, we are able to note one or two common facts. In acute uncomplicated influenza albuminuria occurred 57 times in 447 specimens, or 13 per cent., at the Magee Hospital. Here we dealt entirely with the young adult. At the Mercy Hospital 88 positive results of albumin in 344 specimens, or 26 per cent., from patients of all types were recorded. The common total would be 781 specimens examined, and 141, or 17 per cent., showing albumin.

With the advent of pneumonia the incidence of albuminuria was increased. At the Magee Hospital it was seen 49 times in 70 examinations, or 70 per cent.; while at the Mercy Hospital 106 positive results were found in 133 specimens examined, a percentage of 79. The combined figures, therefore, would show 155 out of 203, or 76 per cent.