978 Albuminuria. 



so that an existing precipitate has not been formed by serum albumen, but by 

 another substance which is as yet unknown. Henn also doubts the occurrence 

 of serum albumen in the urine of healthy animals. 



Except in the true or renal albuminuria, albuminous sub- 

 stances also occur in the urine when blood serum, blood, pus, 

 etc., is mixed with the urine somewhere in the urinary passages 

 after it has left the renal tissue, or derived from the genitals 

 (vagina, prostata). This constitutes spurious albuminuria. 



Diagnosis. The recognition of albuminuria depends upon 

 the chemical demonstration of albuminous substances in the 

 urine; but since albuminuria is only a symptom of several dis- 

 eases, clinical examination must discover also the underlying 

 organic disease. 



Demonstration of the Albumens which are Preformed in the Blood. (Serum 

 albumen and serum globulin.) For this Heller's ring-test is especially adapted 

 and as small an amount as 0.02% of albumen can easily be demonstrated with it 

 (Hammarsten) ; it is made as follows: A small amount of the urine, which has 

 previously been filtered, is carefully poured into a test tube containing concentrated 

 nitric acid, so that it "over-lies" the acid. At the point of contact of the two 

 liquids a sharply defined white ring forms, the depth of which varies according to 

 the amount of albumen present. 



For the boiling test a few cubic centimeters of urine are heated to boiling 

 in the test tube and are then acidulated by the addition of 5 to 10 drops of 

 concentrated nitric acid. A precipitate which has been produced by earthy phos- 

 phates or carbonates will then dissolve, but one due to coagulated albumen persists. 



The acetic acid-ferrocyanide of potassium test is made thus that up to about 

 2% of acetic acid is added to the urine and then a 5% solution of ferrocyanide 

 of potassium, the latter drop by drop and avoiding an excess. If albujiien is 

 l)resent a decided turbidity or a flocculent precipitate appears. This test may be 

 made like Heller's test, a mixture containing a few cubic centimeters of dilute 

 acetic acid and a few drops of ferrocyanide of potassium solution being made 

 to over-lie the urine. 



Spiegler's test seems to Ije particularly sensitive and is said to be exact 

 for a minimum of 1:350,000. A test tube is filled one-half with a mixture containing 

 8 parts of mercuric bichloride, 4 parts of tartaric acid, 20 parts of glycerin and 

 300 parts of water; the urine is then allowed to run down the wall of the test 

 tube drop by drop, when a white ring is formed at the point of contact. 



In the salicylic sulfonic acid test of Eoch a few crystals of salicylic sulfonic 

 acid are added to a few cubic centimeters of urine, when turbidity results. 



The Metaphosphorie acid test after Hindenlang is made by adding an aqueous 

 solution of metaphosphorie acid to the urine; the result is opalescence or cloudiness. 



Esbach's reagent, prepared by Merck in tablet form, is also adapted for 

 practical purposes. 



In the trichloracetic acid test after Eaabe a small crystal of trichloracetic 

 acid is added to a cubic centimeter of urine; at the point of contact a sharply 

 defined turbid zone occurs. 



Henn recommends the following tests for albumen: the boiling test, the 

 acetic acid ferrocyanide of potassium test, the metajihosphoric acid test (for dog 

 urine), the salicyl-sulfonic acid test (for horse and cattle urine), the trichloracetic 

 acid test (for horse and cattle urine), Spiegler's test (for cattle urine). 



For the quantitative determination of albumen Esbach's albuniinometer is 

 adapted for the requirements of practice. Acidulated urine is poured in to the 

 sign U, the reagent up to E (1 part of picric acid, 2 parts of citric acid, and 

 100 parts of water) ; the tube is closed with a rubber stopper and slowly turned 

 over several times without shaking; after standing at room temperature for 24 

 hours, the precipitate has settled and may be read off. The figure indicates the 

 proportion of albumen per mille. Urine which contains very much albumen must 

 first be diluted with water and the indicated figure must then be multiplied with 

 the figure of the dilution. 



If serum albumen has been demonstrated in the urine with 

 the customary chemical tests, it remains to be determined 



