190 CORTEX 



sufficiency results in a period of diuresis in which the accumu- 

 lated nitrogenous and other catabolites are excreted. This 

 diuresis differs, however, from the initial diuresis which ushers 

 in cortical insufficiency by a diminished excretion of sodium. 

 The restored kidney is now able to excrete the waste products 

 of the blood while retaining the essential constituents. As 

 the kidney resumes its normal activity, the excessive concentra- 

 tions of potassium and magnesium in the blood are excreted 

 or restored to the tissues; the water, sodium, and chloride of 

 the blood are replenished from ingested food and fluid; and 

 the normal distribution of the various inorganic constituents 

 in the body is restored. 



The argument has been advanced that the loss of sodium 

 chloride in adrenal insufficiency can not be attributed to 

 damaged renal function because the loss of this substance is 

 notably greater than the loss of water. This view ignores our 

 modern concept of the role of filtration and reabsorption in the 

 elaboration of urine. The assumption of an interference with 

 reabsorption as outlined above not only explains the facts but 

 is in accord with modern views of renal function. The view 

 that the adrenal cortical hormone in some way controls "os- 

 motic pressure" is too fantastic to require comment. The 

 assumption that the hormone controls the electrolyte level of 

 the blood by some mysterious hormonal regulation is equally 

 unnecessary if we accept the view (for which there exists both 

 anatomical and physiological evidence) that the renal tubules 

 are injured and are unable to perform their normal reabsorp- 

 tive and secretory functions. 



The view that the accumulation of non-protein nitrogen is 

 secondary to the fall in blood pressure is contrary to the avail- 

 able facts. The blood pressure is still normal at a time when 

 the non-protein-nitrogen blood level is markedly elevated. 

 The increased non-protein-nitrogen of the blood must be 

 looked upon either as a further consequence of the renal injury 

 or as a mechanism to maintain a normal osmotic pressure of 



