A Comparison of the Well Known Forms of Kidney Disease.


Related entries: ElTh-May1908 - ElTh-May1908 - ElTh-May1908 (kidney disease chart)
Other tomes: Ellingwood

Acute nephritis Parenchymatous nephritis Interstitial nephritis Amyloid kidney
Onset Parenchyma immediately involved, followed quickly by involvement of entire structures. Parenchyma alone involved. Large white kidney. Connective tissue involved; this causes degeneration, and contraction of entire organ; small red kidney results. Degeneration of structure uniform; deposit of lardacine throughout the organ.
Etiology Develops quickly from primary congestion from cold or from direct injury. May follow excessive drinking; in childhood follows infectious diseases; follows the taking of poisons. Occurs in childhood and early adult life. Occurs without explainable cause, follows bad habits of the system—chronic disease, alcoholism, and chronic derangement of the stomach; occurs between ages thirty-five and forty. Terminates in from two to four years. Excessive diet of nitrogenouos food; chronic stomach or liver disorder; abosrption of lead, mercury, phosphorus, and other irritating substances; follows alcoholism; occurs after the age of fifty; runs slow course; may last for fifteen or twenty years. Occurs with amyloid degeneration of other organs; common where there are changed conditions of the blood from bad habits of the system; it follows chronic infectious diseases; occurs from prolonged suppuration, either of bony or soft tissues.
Pathology Hyperemia first; size increased; cortex uniformly swollen; pyramids appear like raw beef; capsule non-adherent. Kidney increased in size, pale color, cortex uniformly infiltrated, swollen, capsule non-adherent. Kidney contracted; small, red and hard; cortex atrophied; capsule adherent and much thickened, as the disease involves the enveloping structures. Kidney large, waxy or fatty in appearance; cortex pale; capsule non-adherent.
Symptoms Chill, with sudden rise of temperature. Aching in muscles of the back; nausea; vomiting; hot dry skin; flushed face; contracted pupils; restlessness; mild delirium. Pulse sharp and hard; ultimately small, wiry and rapid; urine scanty; dark, smoky, sp. gr. 1026 to 1034; large quantity of albumin. Uremia with edema after second or third day. Presence determined by albumen in urine, often no previous symptoms unless urinary irritation; later progressive debility: general failure; chronic indigestion; conspicuous gastro-intestinal disturbance; headaches and progressive anemia; constipation; urine scanty, dark, high sp. gr.; large quantity of albumen; later edema followed by general dropsy; heart complication conspicuous; anemia extreme; uremia in later stages; extreme anorexia; diarrhea and severe uremic headache. Fatigue; lack of energy; headaches; defective action of stomach and bowels; slowly increasing polyuria; increasing thirst; urine pale, large quantity; sp. gr. at first 1008 to 1010, later 1001 to 1005. Albumin very small; disease may exist for some years before discovered; finally great abatement of vital force, nearly always preceded by failure of digestive functions; urine finally greatly deficient, without much increase in sp. gr.; diarrhea, uremia, heart complications severe; dropsy. Anemia slowly developing and persistently progressive; gradual failure of vital forces; permanent and increasing debility; intractable derangement of the gastro-intestinal tract. Chronic enlargement of the liver and spleen, with chronic diarrhea; occurs late in life.
Diagnosis When disease follows sepsis, uremia or edema are the first symptoms. Urine abundant, pale, dropsy advances rapidly; hebetude; convulsions; sudden occurrence, rapid course; urinary irritation: terminates within a few weeks. Occurs between ages 35 and 40. Terminates in from two to four years; urine scanty; dark; high sp. gr.; large quantity of albumen; white if no hemorrhage; dark if mixed with blood corpuscles. Occurs after the age of fifty; most common in men; lasts many years; urine large quantity, colorless, low specific gravity; but very little albumin; uremia and dropsy only at termination. Serum albumin present in the urine; unusually large proportion of globulin.
Prognosis Good if from cold; not unfavorable with careful, prompt treatment, if from infection. Good if taken early; unfavorable in later stages. Disease never cured; may be prolonged until patient reaches old age. Fatal; treatment sustains vital forces, somewhat prolonging life.
Treatment Persistent hot applications to the back; free transpiration from skin; relaxation, and reduction of tension, by gelsemium, macrotys and aconite; later jaborandi, apocynum, magnesium sulphate, digitalis, and elaterium to remove effusion; veratrum, hyoscyamus and chloral to control convulsions; echinacea for toxemia. In children, following other diseases, belladonna and santonin to overcome suppression. Alcoholics and tobacco prohibited; tea and coffee greatly restricted; skimmed milk freely; normal salt solution, hot, in rectum each night; ethereal tincture of iron; nux vomica, and tonics. Gallic acid if much albumen or blood; support the heart; antagonize dropsy when present with indicated remedy; pay most careful attention to general nutrition. Preserve integrity of stomach and intestinal glandular organs; also of red blood corpuscles; guard against cachexia; keep digestion perfect; select remedies with reference to existing conditions. Residence in mild climate almost imperative. Cannot resist cold. Must be diagnosed early; eliminate every dyscrasia; purify the blood perfectly, calcium sulphid and echinacea will prevent suppuration; preserve tone by glycerophosphates and hypophosphites; give iodin oxide of iron or the ethereal tincture of iron; adapt other tonics as indicated. Adopt the severe hygienic dietary and climatic measure advised for interstitial nephritis.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.