Anomalies of Secretion.



Definition:—Absence of urine, from suppression or from complete failure on the part of the kidneys to secrete.

Etiology:—The condition arises from an occlusion of the renal vessels by a thrombus or an embolus, as the result of intense acute congestion, from cold, from local irritation or from the taking of irritating medicines, or poisons; from shock; from the administration of anesthetics, from severe surgical operations, from reflex irritation, as from nephrolithiasis or catheterization; from sepsis, especially from septic absorption after miscarriage or labor. It also occurs from the nephritis of scarlet fever, in the stage of collapse following yellow fever and cholera, and as a result of hysteria. A form of absence of urine in the bladder, which is occasionally classed as anuria, improperly, is due to the presence of a calculus in the ureter. This is one form of retention, the urine being retained in the kidney pelvis.

Symptomatology:—At first there are no symptoms. Occasionally twelve or eighteen hours will pass before the patient will notice that no urine has been voided. At that time there may be some backache, with mild nausea, and perhaps vertigo upon an attempt to rise or walk. Any fact that would arouse a suspicion that there was imperfect secretion of urine should cause the physician to introduce a catheter, when the absence of urine in the bladder would be confirmatory. In septic cases the nervous system becomes irritated very early, and as a result convulsions may appear abruptly before the symptoms have been regarded with suspicion. This may be followed by stupor, and ultimately profound coma; the temperature is usually subnormal, the pulse, at first rapid and hard, is later soft, rapid and feeble, and often irregular.

I have observed five cases of anuria, occurring from three to fourteen days after confinement, or after miscarriage, which I have attributed to septic absorption. In no one of the cases was there evidence of nephritis prior to the expulsion of the contents of the womb. These exhibited a train of symptoms not different from those just described.

Diagnosis:—The condition may be suspected from the symptoms, but a positive confirmation is made only by the introduction of the catheter. Retention of the urine in the pelvis of the kidney, from sudden occlusion of the ureter, is accompanied with agonizing pain, and may be thus readily excluded.

Prognosis:—Whatever the cause, the condition is a most serious one, a very large percentage in general practice proving fatal. A full, immediate appreciation of the seriousness of the condition and the adoption of a most thorough and persistent course of treatment is essential to the saving of the life of the patient.

Treatment:—Conservative measures, a mild course of treatment while waiting for the kidneys to act, will prove fatal. The patient should be at once put into a hot bath, then dried, wrapped in warm blankets and put to bed; a compress wrung from hot water should be applied across the loins, and over this a rubber water bag which contains a pint of water as hot as can be borne, all air being excluded from the bag. This may be kept in place by a wide, firm towel as a bandage around the body. When the temperature of the compress approaches that of the body, it must be removed, and again applied as hot as can be borne. To the patient should be administered, from the first, three drops of specific gelsemium and one drop of specific macrotys, in water, every hour. If the macrotys headache appears, this remedy may be suspended for a few doses, and a mixture then prepared which contains, in four ounces of water, a dram of gelsemium, twenty drops of macrotys and three drams of hydrangea. This should be given every hour. This course has been satisfactory with me with most cases. In an occasional case I have persisted with the hot applications over the kidneys for from three to five days. I believe that more is accomplished by this course than is possible by any medicinal treatment alone. No medicine must be given internally which will in any way irritate the kidneys. The use of the potassium salts or the spirit of nitrous ether must be avoided.

Occasionally secretion from the skin should be sustained, if the heart will stand the depressing influence of the remedy, by the action of jaborandi or pilocarpin. Where the patient is sthenic and has been previously vigorous, one-fourth of a grain of pilocarpin may be given at the onset; but I have succeeded in my cases without this depressing remedy.

As soon as the kidneys begin to act, and even a little urine is excreted, as may be determined by catheterization, an infusion of smartweed or of epigea or triticum may be administered, but I do not at first advise the taking of large quantities of fluids. A dose of the sulphate of magnesium once or twice daily will keep the bowels free and will prevent the occurrence of dropsy.

The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.