Bright's Disease of the Kidneys. Albuminuria.
This peculiar disease was first explained to the profession in 1837, by Dr. Bright, of England, whose name it took. It consists of a disorder of the kidneys, probably a congestion and an obstructed circulation in them, from which arise two most important effects ; first, albumen, an essential alimentary constituent of the blood, is secreted and passed off, in larger or smaller quantities, in the urine; and secondly, urea, the worn out matters of the blood which the kidneys are made expressly to carry off, is permitted to remain. If the urine of a person having Bright's disease be examined, therefore, albumen, which should not be there, will be found, and urea, a natural constituent, will be absent. The presence of albumen, however, while abnormal, is not necessarily indicative of Bright's disease, as it may proceed from indigestion and blood disorders.
Method of Examination. To discover albumen in urine suspected to contain it, place a little in a test tube, and boil it over a spirit, lamp. If albumen be present only in minute quantity, it may cause only a delicate opalescence ; if in larger quantity, it may separate in curdy flakes, and fall to the bottom as a more or less abundant white precipitate. If very abundant, the liquid way become nearly solid.
The albumen is the same as the white of an egg, and the boiling has the same effect in whitening and hardening it, as upon that substance.
Albumen is sometimes found in the urine in a coagulated state, and having the shape of tubes or worms (Fig.112). This is quite common in Bright's disease. The deposit seems to be made up of fibrous casts of the uriniferous tubes of the kidneys.
Symptoms. The two unnatural conditions mentioned above give rise to the symptoms of Bright's disease. One of them, however, is itself the most constant and characteristic symptom of the disease, namely, the presence of albumen. This, too, being one of the nutritive constituents of the blood, its abstraction thins the serous portion of the blood, and causes it to filter out of its vessels into the cells, causing dropsy of the cells, usually called cellular dropsy, or anasarca. This general dropsy begins frequently in the face, and spreads rapidly over the whole body and limbs. In addition to this, there are pains in the back and loins, a gradual failing of strength, and a derangement of digestion. The skin becomes dry, with a pale and bloodless appearance, and there are frequently thirst, nausea and vomiting. The urine frequently has fat, blood, epithelial scales, mucus, blood discs, fibrous casts of the uriniferous tubes, and saline sediments; and is generally lighter by weight than in health, and less in quantity, and is apt to be red, brown, or dingy in color.
The retention of urea in the blood acts as a poison, and causes, toward the latter end of the disease, when accumulated in large quantity, drowsiness, convulsions, and apoplexy.
A frequent desire to make water, with a shifting back and forth of the bowels between costiveness and diarrhea, are common symptoms.
Treatment. The results of treatment in this disease are often unsatisfactory. Yet if taken in season, investigated with proper care, and treated with due diligence, much may be done for its cure. It is one of those harassing complaints, which physicians in family practice seldom have the patience to investigate and manage with sufficient care.
Let the healthy and active condition of all the vessels of the skin be the first object aimed at. This will relieve the laboring and faltering kidneys of a portion 'of their burden. The alkaline sponge bath with vigorous friction every day will secure this object.
In the next place, the skin being put in a working condition, should be made to work by some internal diaphoretic, as the tincture of veratrum viride, in doses of from five to ten drops, or the compound tincture of Virginia snakeroot, in teaspoonful doses.
The kidneys may be still further relieved, especially when there is considerable tenderness and other signs of inflammation, by applying mustard poultices and croton oil externally.
The bowels should be regulated by some gentle physic, as cream of tarter dissolved in flaxseed tea, rochelle powders, epsom salts, etc. In some cases, podophyllin and leptandrin (40), or the compound powder of jalap (41), are useful.
When there is dropsy of the cells, elaterium may be used as physic (31), or the kidneys may be jogged by digitalis (130), (129), its effects being carefully watched. Cider, freely drunk, has been found useful in some cases.
To restore the blood, iron (73), (93), (74), (75), (72), (71) is the essential article. When there is considerable debility, some of the vegetable bitters, as quinine, quassia, gentian, colombo, etc., may be used daily. Coffee, and all indigestible articles of food, as rich pastries, new bread, high seasoned meat, and fats, must be avoided, in a word, nothing must be taken, either in kind or quantity, which the stomach cannot easily digest.
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