METABOLISM IN NEPHRITIS 313 







factors may be involved. The marked reduction of metabolism, as meas- 

 ured per square meter of surface, found in cases of nephritic edema points 

 to some other cause than mere dilution of tissue and distention of skin 

 (Aub and DuBois). 



High Blood Pressure. According to Aub and DuBois, this has no 

 constant influence on the total metabolism. An increased arterial tension 

 may be associated with cardiac insufficiency- and marked arteriosclerosis. 

 The latter may bring about a deranged function in almost any organ. It 

 is therefore only to be expected that cases of hypertension should show wide 

 variations in their total metabolism which are not necessarily the result 

 of uncomplicated hypertension. An increased blood pressure without 

 secondary changes, as the authors quoted above have shown, evidently does 

 not affect the total metabolism. 



Acidosis has little effect on the total metabolism in nephritis (Pea- 

 body, Meyer and DuBois). It is well to bear in mind that the acidosis 

 encountered in nephritis is usually due to inability of the kidney to excrete 

 certain acid substances which, under normal circumstances, it eliminates 

 very readily. In the type of acidosis brought about by a diminished car- 

 bohydrate utilization, either on carbohydrate free diets or in diabetes 

 mellitus, there may be an increased total metabolism which Lusk has 

 ascribed to an accelerated protein consumption during the carbohydrate 

 free periods. In cases of nephritis, associated with nausea and vomiting, 

 or on a starch free diet, or on starvation treatment, the second form of 

 acidosis would increase the metabolic rate in nephritis. 



Renal Function. The effect of diminished water excretion and its 

 accumulation in the body tissues has been discussed under edema. Renal 

 function as measured by the phtha'lein output, the non-protein nitrog- 

 enous constituents of the blood or Ambard's coefficient, even when it was 

 very much impaired, did not alter the level of the total metabolism (Aub 

 and DuBois). 



Summary. In nephritis, according to the most recent investigations, 

 the total metabolic rate appears to be normal, except when the disease is 

 complicated by dyspnea, which results in an increased metabolism, and 

 when associated with edema, which lowers the metabolic level. The rea- 

 son for either of these phenomena is not entirely clear. 



Clinical Application. Most cases of nephritis maintain their nutri- 

 tion perfectly while on a normal diet; many of them become obese from 

 overeating. In such individuals a normal metabolism probably exists. 

 Uremic states, characterized by loss of appetite, nausea and vomiting, and 

 the increased metabolism which must of necessity accompany muscular 

 twitchings and convulsions, may play havoc with many of the scien- 

 tifically calculated diets and necessitate an altered schedule of feeding if 

 the metabolic requirements of the individual are to be met. 



The loss of large amounts of albumin in the urine will in some in- 



