Vander Hoof considers his subject under Senator's headings, namely, 1, Acute nephritis, (a) parenchymatous, (b) diffuse; and 2, chronic nephritis, (a) diffuse, and (b) indurated. He discusses chronic uremia fully, and states that a large proportion of cases are not diagnosticated; owing to failure to appreciate the various symptoms of chronic uremia, so that the physician's attention is not directed to the renal insufficiency as the cause of ill health.
Chronic uremia is a toxemia occurring more or less in all cases of chronic nephritis and with a symptom-complex of considerable diversity. Most disturbances arise in the nervous and digestive symptoms. The motor convulsive symptoms of acute uremia are replaced in the chronic form by mental disturbances; the patients may be apathetic, even somnolent, but sleep is not restful, and even pronounced insomnia may occur.
There may be mental confusion, with difficulty in remembering names or recognizing familiar faces; or profound melancholia or mental depression with delusions of persecution. Recurring and persistent headache, frequently occipital, is the commonest symptom.
Tonic contractions of different groups of muscles are prominent. Frequently, there are cramps in the calves of the legs, especially at night, and severe and recurring abdominal colic; the pupils are usually contracted, although they dilate in acute uremia. Vertigo is frequent. Various forms of palsies may occur, including strabismus, monoplegia and hemiplegia. Numbness and tingling in the extremities are observed.
The disturbances in the gastrointestinal tract are usually periodic; the tongue is heavily coated and there is a foul taste in the mouth. Such symptoms as the foregoing, occurring in persons of the age at which chronic interstitial nephritis is common, should always direct attention toward this lesion, and the presence of increased pulse tension, accentuated second aortic sound, and the history of increased frequency of urination, make the diagnosis very probable, even before the urine is examined.
Vander Hoof discusses the eye and urinary conditions, and with regard to the latter says that attempts to estimate the functional activity of the kidneys by cryoscopy, the degree of glycosuria after the use of phloridzin, and the rapidity of the excretion of methylene blue, can not be said to have made for themselves a place of value among our diagnostic aids for the recognition of nephritis.—Jour. Am. Med. Ass'n.