METABOLISM IN NEPHRITIS 



339 



tissue is correct, a very important fact will have been developed. The re- 

 port of Heilner, that urea ingestion may be responsible for protein destruc- 

 tion because there is a marked increase in urea excretion, is very far- reach- 

 ing- if true, but obviously needs extensive verification. Bradford's findings 

 that in dogs with partially extirpated kidneys, 25 per cent of the original 

 renal tissue remaining, there are polyuria, excessive urea output, rapid loss 

 of weight and strength, finally terminating in death at the end of one to 

 three weeks, are extremely suggestive of what may occur when marked 

 renal insufficiency exists. These results and those of Becker supplement 

 each other beautifully. It is obvious that the animal experiments must be 

 repeated and the observations applied to patients before they can be ac- 

 cepted as proved and their importance fully realized. However, they 

 suggest very significant possibilities. 



In regard to studies in human nephritis, it has already been men- 

 tioned that calorimetric determinations failed to reveal the presence of an 

 abnormal degree of protein destruction, and the unsatisfactory case re- 

 ports of Von Noorden and Richter have been referred to. Frothingham 

 and Smilie examined some patients concerning which they say: "A 

 marked increase of non-protein nitrogen in the blood of over 150 mg. per 

 100 c.c. appeared from our cases to come on just a few days preceding 

 death and we looked on it as a terminal phase of the disease." Mosenthal 

 and Lewis reported several instances of protein disintegration in Bright's 

 disease. All of these patients did not succumb; all of them, however, 

 were seriously ill. 



TABLE 18 



DATA FROM A CASE OF (CONVULSIVE) NEPHRITIC TOXICOSIS IN A PATIENT SUFFERING 

 WITH AN ACUTE EXACERBATION OF A CHRONIC NEPHRITIS, ILLUSTRATING THE OC- 

 CURRENCE OF PROTEIN DESTRUCTION 



* The patient could not be controlled and somo of the urine was unavoidably lost. Anuria was 

 not present at any time. 



A case which illustrates the course of the process of protein destruc- 

 tion in Bright's disease is detailed in Table 18. In this patient the amount 

 of nitrogen retained in grams was arrived at in the same way as described 

 in the section on the nitrogen balance, in nephritis. This man, a negro 

 46 years old, took very little food. The retention of 6 grams of nitrogen 

 per day during the first 16 days, while more than 7 grams per day were 

 eliminated in the urine would indicate some increase in the rate of protein 



