

Metabolism in Nephritis 



HERMAN 0. MOSENTHAL 



NEW YORK 



Introduction 



There has been a marked tendency in the past to regard all cases of 

 nephritis as being a problem of renal insufficiency only. This side of 

 the question has been worn threadbare by medical and chemical research ; 

 very far-reaching results have been achieved, but the solution of the ques- 

 tion of what pathological processes or toxic factors are responsible for most 

 of the signs and symptoms of nephritis, such as uremia, edema, headache, 

 hypertension, etc., still remains unsolved. However, the problem has 

 been more closely defined and much has been gained thereby. Three 

 very different factors may be regarded as shaping the disease we are 

 pleased to call nephritis. These are : 



1. Degenerative changes, affecting principally the tubules of the kid- 

 ney, which have been termed the nephroses. 



2. Inflammatory changes, involving a part or all of the renal struc- 

 ture. 



3. Renal insufficiency, which develops in its pure form in the uncom- 

 plicated arteriosclerotic kidney. 



In considering these three factors it becomes very evident to the student 

 of nephritis that the kidney is only a cog in the wheel of the clinical 

 picture of this malady. Degeneration, inflammation, arteriosclerosis and 

 renal insufficiency affect the blood vessels and tissues of the whole body 

 either at the onset of the disease or secondarily. The result is an interlac- 

 ing of various signs, symptoms and pathological processes that is only be- 

 ginning to be unraveled. The outstanding feature of the whole situation 

 is that renal insufficiency and its sequelae form a clinical symptom complex, 

 of which the effects and signs may be judged with some degree of precision, 

 while the role played by degenerative and inflammatory changes remains 

 an enigma. This is due in large part to the fact that the former is a con- 

 dition whose cause is localized in the kidney, while degeneration and in- 

 flammation can not be regarded as purely renal affections, but must be 

 looked upon as constitutional states in which every tissue in the body is 

 involved. It is only on this supposition that many of the symptoms of 



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