The value of tests for renal function in early and advanced Bright's disease / by R. Fitz, M.D., Boston, Massachusetts.

  • Fitz, Reginald, 1885-1953
Date:
[1914?]
Catalogue details

Licence: In copyright

Credit: The value of tests for renal function in early and advanced Bright's disease / by R. Fitz, M.D., Boston, Massachusetts. Source: Wellcome Collection.

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    edema in which the phthalein output was normal, and Baetjer22 reports nearly similar cases. Foster23 illustrates the difficulty of prognosis by the use of any one kind of functional test giving as examples cases which died of uremia with a practically normal phthalein output shortly before death. In this regard the following case is of interest. Case IV.—Peter Bent Brigham Hospital. Medical No. 4. A woman, aged sixty-three years, was admitted to the hospital with a history of dyspnea of one year’s duration. Her family and previous histories were negative. Her habits were good. Two months before entry her eyesight had failed, and she began to have mild occipital headaches. Physical examination was unimportant except for marked cardiac hypertrophy, an apical systolic murmur, an increased blood-pressure (232 mm. systolic), and a urine which contained albumin and casts. She appeared to be a case of advanced interstitial nephritis, confirmed by a phthalein excretion of 12 per cent, for two hours. Rest in bed produced no benefit. In two weeks she became drowsy and was bled. On the following day the phthalein excretion was 30 per cent, for one hour and twenty minutes. Her general condition did not improve. A week later she became comatose and put out only traces of phthalein in two hours. She was bled again. She became brighter temporarily, and her phthalein excretion on the next day was 54 per cent, for two hours. She lapsed into coma soon and died shortly. On the day of her death she put out 8 per cent, of phthalein in two hours. Autopsy showed typical contracted kidneys. It is difficult to explain this rapid premortal rise in the excretion of phthalein on any other ground than that bleeding had in some way rendered the kidney hyperpermeable to the dye without having any definite influence on the disease. But, on the whole, the phthalein test is of great value. These latter observations merely emphasize that to judge the degree of renal insufficiency with accuracy more than one test must be used. Of substances studied in the blood of nephritics the concentra¬ tion of the incoagulable nitrogen and urea has been found to be of most importance. Folin and Denis24 and Marshall25 have recently devised relatively simple methods for performing these analyses, making possible such estimations as a matter of routine in hospitals with well-equipped laboratories. In regard to the technique employed, readers are referred to the original articles. The older methods required large amounts of blood, and were time-consuming. Nevertheless, Ascoli,26 Strauss,27 and others found in severe grades 22 Arch. Int. Med., 1913, xi, 593. 23 Arch. Int. Med., 1913, xii, 452. 24 Jour. Biol. Chem., 1912, xi, 527. 25 Ibid., 1913, xv, 487. 26 Pflilger’s Arch. f. d. ges. Phys., 1901, Ixxxvii, 103. 27 Die Chronische Nierentziindungen in ihrer Einwirkung auf die Blutfliissigkeit und deren Behandlung, Berlin, 1902, A. Hirschwald.