A system of practical medicine. By American authors. Vol. 4

by Unknown

After an epileptic attack albumen may appear in the urine for a short time, disappearing within a few hours. This occurrence might lead to an erroneous diagnosis of uræmic convulsions if the examination happened to be made shortly after a fit and not repeated at a later period. Transitory mania may perhaps be placed in the same category.

Chronic mental disease, like general paralysis of the insane, is frequently accompanied by albuminuria, and even temporary mental disturbance in a sensitive person has been known to excite the symptom.

In narcotic poisoning both by alcohol and by opium a similar state of things sometimes occurs. With alcohol, however, distinction is to be made between chronic cases, where a suspicion of parenchymatous nephritis may be fairly entertained, and acute alcoholism or delirium tremens, where the albumen appears and disappears within a few days. In a patient profoundly under the influence of opium the urine may contain not only albumen, but casts, and the diagnosis of uræmic coma is very likely to be made if nothing is known about the history—an error which might be of great consequence, as tending to discourage the efficient treatment necessary in opium-poisoning or causing the waste of time on inefficient measures.

It is obvious from what has been said that the diagnosis of albuminuria as a symptom is sufficiently simple with a little care in chemical manipulation, but that its significance is not so easy to determine in every case, since it is found in so many cases unconnected with chronic or progressive renal disease, and on the other hand may be absent while serious nephritis is going on.

Albuminuria, as defined at the beginning of this article—that is, occurring in the absence of chronic and serious renal disease—is only to be diagnosticated by the exclusion of such diseases, by careful consideration of all the symptoms present, such as changes in the quantity and specific gravity of the urine, in the force, rhythm, and size of the heart, and of the arterial tension, as well as the relation of the amount of albumen to the amount of urine and character of the sediment as indicating one or the other form of nephritis. Thus a very small amount of albumen with a highly concentrated urine is not likely to be met with in the usual forms of nephritis, but is often found in connection with valvular disease of the heart.

Treatment is but rarely directed to this symptom, since, when albumen is present in but small quantity, as usually happens, it is of little or no consequence except as an important element in diagnosis, while the few cases in which the amount is large enough to constitute a serious drain upon the system are almost exclusively cases of actual Bright's disease, and hence do not come under this head. The administration of astringents, especially tannic and gallic acids, has been found to diminish the quantity of albumen in the urine.

(A copious bibliography of this subject will be found in an article by Ellis in the Boston Medical and Surgical Journal, vol. i., 1880.)

Renal Colic; Renal Calculus.

Renal colic is the appellation of a group of symptoms caused, in by far the greater proportion of cases, by the passage of a renal calculus through the ureter, or sometimes merely its engagement in the upper extremity and impaction or subsequent falling back. Other foreign bodies large enough to cause distension and obstruction, such as clots of fibrin or portions of hydatid cysts, may give rise to the same phenomena. Most physicians, however, have seen cases where the same set of symptoms have not been followed either by the discharge of the stone per urethram or by evidence of its continued sojourn anywhere in the urinary organs. They may occur in persons of a neuralgic tendency in connection with the uric or oxalic diathesis. The conclusiveness of such cases, as proving the possibility of a purely neuralgic or spasmodic attack, must of course depend upon the carefulness and intelligence of the patient and the opportunities of the physician for observation extending over years. As it is admitted, however, that these symptoms may occur without the demonstrated presence of a calculus, it would be perhaps better nomenclature to apply the term renal colic to painful and spasmodic affections of the kidney and ureter, however caused, and to describe the passage of a calculus or other obstruction under its own name.