CHAPTER XXIII 



EFFECTS ON THE URINARY TRACT. KIDNEYS AND BLADDER 



Although not so marked as in many other organs, the effects of inanition upon 

 the urinary tract are sufficient to justify more attention by the urologists. 

 The changes are extensive in advanced stages of malnutrition, and especially in 

 certain types of partial inanition, such as pellagra and thirst. Following a 

 brief summary, the effects of inanition upon the urinary tract will be considered 

 under (.4) total inanition, and (B) partial inanition. The available data refer 

 chiefly to the kidney, with a few observations upon the urinary bladder, ureters 

 and urethra. 



Summary of Effects on the Urinary Tract 



During both total and partial inanition in the adult organism, the kidneys 

 undergo atrophy and loss of weight to a variable degree, but usually relatively 

 much less than the loss in the body as a whole. In the young, the kidney is still 

 more resistant to loss in weight, and may even increase considerably while the 

 growth in body weight is suppressed by chronic inanition. 



In structure, the kidney usually appears nearly normal in the earlier stages 

 of inanition, during which the cell-atrophy is much less conspicuous than in 

 many other organs. In later stages, there may be congestion and progressive 

 degenerative changes, which appear exceedingly variable according to the 

 species, age, individual, region of the kidney, length and type of inanition, etc. 



In general the change first observed (aside from congestion) is cloudy swelling 

 in the epithelium of some of the convoluted tubules and Henle's loops. Changes 

 occur also in the mitochondria and related structures, rods, brush border, etc., 

 which have an uncertain relation to the decrease in urinary function. Later 

 the cytoplasm may undergo granulo-fatty or vacuolar degeneration. Nuclear 

 atrophy is less marked, but especially in later stages there is a progressive shrink- 

 age of the nuclei, with a variable degree of pycnosis, and finally karyorrhexis or 

 karyolysis. Casts of various types frequently occur in the tubules, and in 

 extreme cases there may be total degeneration of glomeruli and tubules. 

 Hemorrhages and interstitial sclerosis, pigmentation, etc., are somewhat rare 

 and usually slight in extent. 



The atrophy and parenchymatous degeneration of the kidney are not 

 specific for total inanition, but occur likewise during the various types of 

 partial inanition (as well as in many other abnormal conditions). The changes 

 are particularly severe in certain forms of inanition, such as pellagra; and espe- 

 cially during aqueous inanition (thirst), which apparently causes an intense 

 renal irritation, with round cell infiltration in addition to the above mentioned 



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