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Brights Diseases Albuminuria Degenerations of the Kidney



The most important, because the most frequent, organic diseases of the kidney are those included under the head of Bright's disease, so called from the circumstance that the late distinguished Dr. Richard Bright first recognized the affections and made them known. The College authorities define these diseases as " several forms of acute and chronic disease of the kidney, usually associated with albumen in the urine, and fre quently with dropsy, and with various secondary diseases result ing from determination of the blood." Varieties of Bright's Disease.

There are several varieties now recognized of Bright's disease, which resolve, however, into two great divisions, the acute and chronic.

Acute Bright's disease, called also acute albuminuria, acute desquamative nephritis, or acute renal dropsy, is a disease in which the kidney becomes greatly enlarged and vascular, with its minute convoluted tubes into which the urine is primarily se creted filled with epithelium. The epithelial scales, in the form of casts of the renal tubes, are voided by the urine, together with albumen and sometimes with blood. The obstruction to the flow of urine and the interference with the function of the kidney give rise to the most serious general symptoms. There is fever followed quickly by dropsy, and, in extreme instances, by coma and death. Acute Bright's disease is a rather common complica tion of scarlet fever, and is one of the dangers most to be dreaded in that disease. It is also produced by sudden and extreme chills, and by excessive use of alcohol.

Chronic Bright's disease is either a continuation of the acute affection, or is slowly developed without the occurrence of active symptoms. It is connected with further and permanent changes in the structure of the kidney, giving rise to three subdivisions of the chronic affections called granular, fatty and lardaceous kidney.

Granular kidney, called also contracted granular kidney, chronic desquamative nephritis, or gouty kidney, is a form of the disease coming on, usually, in persons of middle age, and espe cially in those of gouty habit. It is attended with albumen in the urine. The kidney is granular, firm, rough, hard, and gen erally contracted, its membranous capsule adhering closely to it.

Fatty kidney is a condition in which the organ is white and mottled. The secreting cells are granular and contain fatty or oily deposits.

Lardaceous kidney, known also as amyloid or waxy kidney, is a condition in which the organ is, as a general rule, enlarged, and presents on its surface a waxy appearance. This change seems to commence in the vascular structure of the organ, in the minute tufts of arteries that yield the blood from which the urine is secreted. The affection is often connected with fatty and ainyloid changes in other parts of the body, as the liver, and it is, like them, associated not unfrequently with pulmonary consumption, and, specially, with syphilitic degeneration.

In addition to these degenerative changes the kidney is sub ject to deposit of fibrins within its structure. It is sometimes the seat of cancer, of non-malignant tumors, of cysts, of parasitic developments, and of tubercle.

The mechanical diseases of the kidney are : Hydronephrosis. " Dilatation of the pelvis of the organ, or of the glandular structure, into one or more cysts, by retained secretion." Calculus. Stone in the kidney, usually in the pelvis, or in the tube leading from the kidney to the bladder, the ureter. It is a very painful affection, causing often faintness and vomiting dur ing the passage of the calculus.

Movable kidney. A condition in which the kidney is, as it were, dislocated from its natural position and unfixed.

disease, acute, urine, chronic, granular and structure