340 HERMAN O. MOSENTHAL 



destruction. (During starvation, or on a low diet, about 8 grams of nitro- 

 gen a day may be considered as the normal amount that should be excreted 

 by kidneys and intestines.) The retention of 15 grams per day during 

 the next three days and of 45 grams per day for the last three days of life 

 may be considered as absolute proof of the fact that a marked protein 

 disintegration was taking place. In another section (creatin in ne- 

 phritis) the evidence is cited that an increase of creatin in the blood 

 towards the end of life in many nephritics bears witness to the fact that 

 at this stage of their disease protein destruction often occurs. 



It is probable that the same toxic substance that is responsible for the 

 nephritis is also the cause for the loss of body substance, and that the ne- 

 phritis is not the etiological factor upon which the increase in protein 

 catabolism depends. In other cases, as suggested by the experimental 

 evidence cited above, a marked renal insufficiency or an anuria may be 

 found to be the cause for an increased protein disintegration. An ac- 

 celerated protein destruction in nephritis is evidently to be regarded as 

 a symptom of the disease. It usually marks a terminal state, though not 

 in every instance; whenever it occurs, however, the patient's condition 

 is grave. An abnormal degree of protein destruction in nephritis does 

 not occur frequently and when present usually lasts only for a short period. 



Fat Metabolism in Nephritis 



The Utilization of Fat in Nephritis. In nephritis the respiratory quo- 

 tients obtained (Aub and Du Bois, Peabody, Meyer and Du Bois) indicate 

 that fats are metabolized in a normal manner. The acidosis characteristic 

 of certain stages of nephritis is not to be attributed to a faulty fat metab- 

 olism, as it is in diabetes mellitus, but is brought on by a deficient excretion 

 of acids ordinarily eliminated by the kidney. 



Lipuria (Chyluria) in Nephritis. The occurrence of fat in the urine 

 (except for the traces occurring in all urines) has been found rarely under 

 any circumstances, unless the lymph channels were locked by parasites. 

 Sanes and Kahn note that chyluria may occur, in the absence of parasites, 

 by the passage of fat from the blood directly through the kidney epi- 

 thelium; this is probably the result of a functional disturbance of the 

 kidney cells. In their patient .the fat in the urine rose as high as 6 per 

 cent; the urinary fat in this instance was raised by a fat-rich diet and 

 diminished by food low in fats. No signs of renal disease were noted in 

 this case by Sales and Kahn, nor did they come to the conclusion, from a 

 review of the literature, that chyluria was in any way characteristic of 

 nephritis. Bauman and Hausmann report similar findings in a case of 

 nephritis possibly of syphilitic origin. In their patient the lipuria was 

 influenced by the amount of fat in the diet, there was no increase in the 



