Renal action in acute nephritis

Abstract

The clinical discussion of these cases will appear with the functional results in a later paper. In the series are six acute cases and two cases entering the hospital in an acute attack but giving a history of previous renal disease. The phenolsulphonphthalein excretion, the renal test day, the blood urea, the urea index and the chloride index were employed for the functional studies. The renal test day contributed little of value. Nocturnal polyuria was constant but quite independent of the kidneys'ability to concentrate. “Maximal impairment,” according to Mosenthal, occurred in two cases, one showing no other abnormalities of renal function, and the other with very moderate impairment, while a fatal case concentrated to 1.022. The balances of salt and nitrogen so frequently included in the performance of this test were not done because of the obvious unreliability of a twenty-four-hour experiment. Moreover, in view of its great dependence upon a factor so variable as the amount of water excreted, systematic determinations of the specific gravity over a brief period must be very carefully interpreted. Many inconsistent phthalein results were found, but in general the value of the test in acute nephritis may be summed up by saying that variations above a level of 20 to 25 per cent, were rarely of a functional significance coinciding with the rest of the picture. A figure below 20 per cent, was of more serious import, although one case excreting only 15 per cent, recovered completely.

The blood urea estimations proved the most consistently valuable means of determining the severity of the disease in any given case. The highest figure was in the only fatal case, the other high figure was undoubtedly the next most severe, while the two cases without any evidence of retention made the most rapid recoveries.