312 HERMAN O. MOSENTHAL 



nephritis can be explained. It is proposed in the present article on the 

 metabolism of nephritis to summarize the points concerning which some 

 knowledge has been obtained. 



Theodore Janeway once remarked that the three most important prob- 

 lems of Bright's disease were uremia, edema and blood pressure; to these 

 the author would add a fourth : renal insufficiency. It may seem at first 

 g-lance that the subject of uremia includes renal insufficiency ; the two over- 

 lap but nothing more than that ; from the clinical point of view certainly 

 they are not identical. It is hoped that in the following pages an adequate 

 presentation of these subjects is given, with the exception of edema, which 

 is considered in a special section. Some phases of Bright's disease that 

 have often been considered as having a bearing upon the subject of metab- 

 olism in nephritis have been omitted, in part because the author does not 

 believe that the relationship is sufficiently close and in part because 

 the knowledge concerning some of these matters is not far enough ad- 

 vanced to warrant an exposition. 



Total Metabolism in Nephritis 



The total metabolism of uncomplicated nephritis appears to be nor- 

 mal. There are certain complications that alter it, while others do not. 



Dyspnea. Peabody, Meyer and DuBois studied the total metabolism 

 of patients with cardiac and renal' disease and found it to be normal ex- 

 cept when influenced by dyspnea. When this was present, the metabolism 

 increased as much as 49 per cent above normal. The rise in the metabolic 

 rate could not be accounted for on the basis of effort associated with the 

 labored breathing, as the increased muscular work entailed was not suffi- 

 cient; furthermore, there appeared to be no constant relation between 

 the augmented metabolic rate and acidosis (as measured by the carbon 

 dioxid tension of the alveolar air), renal function (as determined by the 

 excretion of phenolsulphonephthalein) or arterial hypertension. What the 

 factor or factors are that determine the high metabolic rate associated 

 with the dyspnea is not, known. Aub and DuBois substantiated the above 

 findings, regarding an increased metabolic rate associated with dyspnea, 

 though their two cases showed but a slight rise, as did some of the patients 

 of Peabody, Meyer and DuBois. 



Edema. Edema is associated with a distinct reduction in metabolism. 

 It may be very marked being as much as 27 and 40 per cent in two 

 cases. It is only to be expected that an organism diluted by inert fluid 

 should show a diminished metabolism according to body weight. In cases 

 of obesity this occurs, but Means (b) has shown that they have the same 

 metabolism per square meter of surface as normal people. Edematous 

 cardiac patients as a rule show an increased metabolism, but here other 



