Again, there is a history of some kidney involvement following one of the acute infectious diseases, or it may follow the nephritis of pregnancy.
Patients suffering from the association of chronic nephritis with hypertension die slowly, usually.
Dilatation of the Arch of the Aorta in Chronic Nephritis with Hypertension, Am.
The arteriosclerosis may occur without nephritis or rise of blood pressure.
In diffuse arteriosclerosis accompanied by chronicnephritis the heart is always hypertrophied.
Smith and Kilgore[9] have shown this to be true in cases of chronic nephritis with hypertension.
This drug has been found of benefit especially in cases where arteriosclerosis combined with chronic nephritis causes cardiac asthma.
Formerly I believed that all high systolic pressure cases were cases of chronic nephritis of some definite degree.
Specific or idiopathic, in which there are no evident causes present; it is sometimes seen in cases of nephritis and diabetes.
Of the three cases in which the result was not satisfactory, one had nephritis with severe Graves' disease, and the third psoriasis.
The nephritis and consequent serous effusions usually appear within three weeks after scarlet fever ends, but cases occur in which the effusions are first observed as late as the fourth and fifth weeks.
It has been seen (page 409), however, that even when acute catarrhal nephritis existed at the time of the attack severe relapsing fever might terminate favorably.
Nevertheless, it is true that a certain proportion suffer fromnephritis however judicious the after-treatment may be.
Cerebral symptoms occurring during scarlatinous nephritis are probably sometimes due to the irritating effect of the retained urea on the nervous centre.
In like manner, a tubercular pneumonia, or a tubercular nephritissuggests an association of neoplastic growth and inflammation, in the lung and kidney.
This is in correspondence with what occurs in other septic diseases, and accounts for the albuminuria and interstitial nephritis which often supervene in the advanced stages.
In fatal cases the lesions of intestinal nephritis have been found at the autopsy.
Although the symptoms in scarlatinous nephritis and uræmia may appear very unfavorable, the prognosis is usually good under prompt and appropriate treatment.
The treatment of a case of chronic parenchymatous nephritis is a task requiring the best judgment and the greatest knowledge that the physician can command.
In certain cases the symptoms of nephritis are very manifest, and in others so hidden that the existence of the affection can be certainly recognized only by a microscopic examination of the urine.
In the treatment of acute nephritis the first consideration is the removal of the cause.
It is not unusual, for instance, for the disposition of a patient suffering from kidney disease to change so materially that the attention of friends is called to the change before any physical symptom of the nephritis has been noted.
If there is an insidious nephritis already at work, its symptoms will be much exaggerated and its progress accelerated by the worries and disquietude of such a time.
The development of pathology has shown us that once there has been serious nephritis or cirrhosis of the liver certain portions of the glands are destroyed and therefore there cannot be any question of cure.
When a patient complains that though his or her tissues used to heal rapidly now they are very slow to heal, it is well to think of nephritis or diabetes but it is especially important to know the local conditions.
Anaesthetics, that is, chloroform and ether, are not well tolerated when nephritis exists, and this adds to the danger of operation in such patients.
When, then, there are symptoms of nephritisit is inadvisable for the patient to be made Superior, and if the symptoms develop after his appointment or election he should be relieved of his responsibilities, at least to a considerable degree.
Sooner or later, in most instances of this disease, whether hypertension, chronic endarteritis or interstitial nephritis or any combination of these conditions is most in evidence, the heart will hypertrophy.
Sooner or later these irritants cause kidney irritation, and chronic interstitial nephritis may develop.
This salt-free diet has been recommended not only in nephritis and heart disease, but also in diabetes insipidus and in epilepsy.
Diabetes causes low blood pressure, provided there are no nephritis and no marked suprarenal stimulation.
In scarlet fever, inflammation of the heart may be due directly to the poison of the disease, or it may be secondary to a nephritis which is so frequent a complication of scarlet fever.
As the heart begins to fail, a dilatation of the right ventricle causes passive congestion of the kidneys, and the chronic interstitial nephritis may progress more rapidly.
Chronic nephritis is often a coincident disease, but the causes of the arteriosclerosis and the nephritis are generally the same.
Of course it should be repeatedly emphasized that chronic interstitial nephritismay be in evidence with either albumin or casts alone, or without either being present.
No contraindications, except chronic nephritis and the presence of kidney concretions.
There is no special liability to interstitial nephritis in articular rheumatism, nor is urate of soda present in the blood in that disease.
Further investigation is needed to determine whether interstitialnephritis is even very exceptionally an indirect consequence of rheumatism, as Lancereaux admits.
Coupland has reported two cases of parenchymatous nephritis associated with inherited syphilis, but advances no proof that it was not an accident.
Case XIII, nephritis and phthisis, belongs also in the renal group.
If it is permitted to count XIV also as renal, a list of eight cases out of the original list of eleven unpleasant-delusion cases is obtained in whichnephritis of some type has been found.
There was an acute parenchymatous nephritis with focal plasma cell infiltrations suggesting acute interstitial nephritis.
Aconite: to lower a high temperature; and in the onset of acute nephritis in scarlet fever.
Aconite: in scarlatinanephritis at the onset of the attack.
There is evidence of late to find a septic cause for most of the nephritides, such as infectious fevers, pyorrhea of the teeth, and like bacterial intoxications; in pregnancy the nephritis may be toxemic from sources that are not bacterial.
Where there is a history of nephritisbefore the pregnancy, this often clears up the diagnosis.
Nephritis is likely to manifest itself in pregnancy earlier than toxemia; albuminuric retinitis is commoner in nephritis, but these facts are no real help in differentiation.
With these clinical symptoms and the history, we may differentiate the nephritis of pregnancy from Bright's disease.
Acute parenchymatous nephritis and hemorrhages into the kidneys are often observed.
When acute nephritis happens in pregnancy convulsions are quite common, and when there are convulsions as a result of either chronic or acute nephritis it is very difficult to differentiate between these convulsions and genuine eclampsia.
Nephritis is often found where there is abruptio placentae.
The kidney trouble is always feared for it may result in uremia and death, or the acute may be followed by chronic nephritis or Bright's disease, which will ultimately prove fatal.
This means poison in the blood occurring in acute and chronic nephritis (inflammation of the kidneys).
If it occurs after acute nephritis the symptoms of acute nephritis subside, but anemia and the changes in the urine persist.
Nephritis is one of the most certain causes, because arterio-sclerosis (hardening and decaying of the walls of the arteries) and hypertrophy of the heart are associated with nephritis, etc.
Nephritis is an occasional complication, and constipation is very usual.
A like change is also probably the cause of the oedema of nephritis and of heart disease.
It has been proved that the kidneys in nephritis find it difficult to excrete certain substances, namely, urea, water, salts, and the purin bodies.
Nephritis also develops in some patients and the treatment is directed as far as possible to prevent its developing into a chronic form.
If, during the course of the disease this complication, should develop, the treatment described for acute nephritison page 336 should be immediately instituted.
Meat should not be added until practically all danger of nephritis is passed.
The nitrogenous foods cannot be eliminated entirely, especially if, as is often the case, the individual suffers from chronic nephritis and is up and about attending to business; but they can be judiciously regulated in the diet.
The regime practiced in acute nephritis gives the most satisfactory results.
During the acute stage of nephritis the kidneys are given as much rest as possible by eliminating all food and restricting the amount of water entering the body.
If the uremia becomes positive, then the treatment laid down for acute nephritis already described must be at once instituted.
It is used in certain cases of nephritis when edema is present.
The tendency of the child to develop nephritis during the second or third week makes the treatment largely dietetic in character.
Should nephritis develop in spite of efforts to prevent it, a farinaceous diet[88] such as is given in these conditions must be resorted to.
A diet used in nephritis and diseases complicated by nephritis (scarlet fever).
In both acute and chronic nephritis and in certain fevers, the bladder at times must be emptied by means of a catheter.
It is this fact which explains the occurrence of nephritis in connection with diphtheria, scarlet fever and other infectious maladies.
In acute and chronic parenchymatous nephritis the quantity is usually very large.
The various degenerative and inflammatory conditions grouped under the name of nephritis have certain features in common.
In nephritis the {57} kidneys are less permeable to the chlorids, and it is probable that the edema is due largely to an effort of the body to dilute the chlorids which have been retained.
Excretion of chlorids is diminished innephritis and in fevers, especially in pneumonia and inflammations leading to the formation of large exudates.
They always indicate hemorrhage into the tubules, which is most {119} common in acute nephritis or an acute exacerbation of a chronic nephritis.
