314 HERMAN 0. MOSENTHAL 



stances necessitate a readjustment of diets if nutrition is to be maintained. 

 The albuminuria in itself may not cause an increased metabolic rate but, 

 if marked, may result in a considerable drain upon the system which 

 calls for replacement if it can be accomplished with safety to the patient. 



There are many instances of loss of weight, and slowly or rapidly 

 developing anemia in certain patients. These usually have marked evi- 

 dences of arteriosclerosis following upon hypertension. Many of these 

 cases, suffering with arteriosclerotic lesions in the kidneys, as well as 

 their other tissues, have been diagnosed as uremia instead of cerebral 

 arteriosclerosis, which they really are. The loss of weight in these per- 

 sons may be ascribed in part to lack of assimilative power, which must 

 of necessity attend a general arteriosclerosis, and in part to a diminished 

 appetite. Exactly what rate the basal metabolism assumes in these indi- 

 viduals is an open question. 



In some patients an accelerated destruction of protein occurs. This 

 may assume considerable proportions. This question will be taken up 

 in greater detail under the heading of protein metabolism. 



Protein Metabolism in Nephritis 



Protein metabolism in nephritis has always been regarded as the 

 pivotal point about which the signs and symptoms of nephritis grouped 

 themselves. This conception was the natural outcome of the fact that 

 the kidney excreted the end products of protein katabolism while those of 

 the fats and starches were largely eliminated through other channels. 

 There are certain very definite changes that occur in the body due to the 

 retention of the waste substances derived from the proteins. However, 

 the realization that renal insufficiency is not alone responsible for the 

 phenomena occurring in nephritis has been slowly forced upon the clin- 

 ician by the extensive use of the recently perfected methods in blood 

 chemistry; many cases of nephritis, exhibiting marked symptoms, ap- 

 parently have no disturbance in their renal excretory function. The con- 

 clusions as to which abnormalities are due to renal insufficiency and which 

 to extrarenal metabolic disturbances in the clinical symptom complex, we 

 are pleased to call nephritis, are very incomplete and rest on evidence 

 which has thus far only been slightly developed. It is .necessary to bear 

 the two possible factors, renal insufficiency and extrarenal disturbances, 

 in mind especially when the subject of protein metabolism in nephritis 

 is considered. 



Utilization of Proteins in Nephritis. The respiratory quotient in 

 cases of nephritis does not vary from the normal ; hence protein utilization 

 may be considered as proceeding in the usual manner (Aub and DuBois, 

 and Peabody, Meyer and DuBois). This is undoubtedly true in the 



