343 



whether it becomes secondarily infiltrated (Landau), appears to be purely 

 a matter of speculation at the present moment. All the theories concerning 

 the blood lipoids in nephritis appear to be in much the same plight. 



There apparently is no definite relation between the degree of choles- 

 terinemia and the blood pressure or the non-protein nitrogen of the blood 

 ( Denis (c), Gorham and Myers, Schmidt, Henes). In the uremic state 

 the blood cholesterol may be normal (Stepp(fr)) or diminished, even if 

 there has been a previous hypercholesterinemia (Heries). 



Carbohydrate Metabolism in Nephritis 



Utilization of Carbohydrates in Nephritis. The utilization of carbo- 

 hydrates, both quantitatively and qualitatively, as shown by calorimetric 

 determinations, is normal in nephritis (Peabody, Meyer and Du Bois, 

 Aub and Du Bois). It is important for the therapeutist to realize this 

 inasmuch as the digestion of carbohydrates constitutes the best means 

 to lower the level of protein metabolism and thus diminish the amount of 

 work demanded from the kidney. 



The relation of carbohydrates to acidosis in nephritis is different from 

 that in some other forms of acidosis. Diabetic acidosis, the best known 

 type of this condition, is the result of the retention within the body of 

 incompletely oxidized fatty acids, whose final change to carbon dioxid 

 and water depends upon the simultaneous utilization starches. In ne- 

 phritis, glucose is metabolized along normal channels and another cause 

 must be sought for the acidosis. This is found in the retention of acid 

 substances by an insufficient kidney. 



In the succeeding chapter, the subject of blood sugar in nephritis is 

 discussed; it becomes very evident from the facts therein that, in some 

 cases at least, the blood sugar is higher than normal and that there must 

 be some interference with the intermediary metabolism of the starches. 

 The possible reasons for this will be taken up subsequently. These find- 

 ings are not necessarily at variance with those of Du Bois and his co- 

 workers previously quoted. It may be that the particular patients in- 

 vestigated with the calorimeter did not have a high percentage of glucose 

 in the blood, or that the rise in blood sugar is brought about by a series 

 of changes which are not reflected in such determinations. 



The Blood Sugar in Nephritis. Since Neubauer (1910) demonstrated 

 an increased blood sugar in nephritis, there have been many investiga- 

 tions of this subject. The results have varied a great deal. Taking all 

 the reports into consideration (Bing and Jakobsen, Frank(6), Hagelberg, 

 Haniman and Hirschman, Hopkins, Janney and Isaacson (c), Myers and 

 Bailey, 1916), E. Neubauer (1910), O'Hare(c) (1920), Port (a), Roily 



