398 HERMAN O. MOSENTHAL 



place, there is very much to be said for Krehl's point of view which he 

 voices somewhat as follows: "I could understand it if any one main- 

 tained that nephritis has no influence whatsoever upon the circulation 

 I almost believe this myself. This at least is true: neither the localiza- 

 tion of the lesion in the kidney nor the extent of renal involvement is 

 of any significance. It is only through functional disturbances that the 

 kidney may be considered as being a factor." 



However, inasmuch as nephritis is frequently accompanied by hyper- 

 tension, and there are certain theories that ascribe the cause of increased 

 blood pressure to a metabolic disorder, it is worth while to consider this 

 subject in this section of the present book. 



Occurrence of Increased Arterial Pressure in Nephritis. An increased 

 blood pressure has been noted in all forms of nephritis ; at the same time, 

 it must be borne in mind that the opposite is equally true, namely, that all 

 types of kidney disease have been observed when hypertension was not 

 present. Any arguments therefore based on the fact that one or the other" 

 forms of Bright's disease is accompanied by hypertension, or vice versa, 

 is not conclusive. 



Acute Nephritis. True acute di|Fuse nephritis is supposed to exhibit 

 an increased blood pressure, at least for a short period. It may be pres- 

 ent for only a day or two or persist indefinitely. The height reached 

 varies considerably. Janeway (c) observed that hypertension was not al- 

 ways present but may rise as high as 190. Rolleston, Weigert (&), Butter- 

 man and many others have noted similar findings, the hypertension in some 

 instances reaching a level of 240 mm. of mercury. According to Volhard 

 the blood pressure is more frequently below 160 than above this level. It 

 therefore does not usually reach the very high figures associated with essen- 

 tial hypertension. 



Volhard is largely responsible for the present attitude of many in re- 

 gard to the problem of blood pressure in acute nephritis ; some of his state- 

 ments concerning it may therefore be of interest: "The pathognomonic 

 symptom of the typical diffuse glomerulonephritis is an increased arterial 

 pressure. When it is present in the course of an acute renal condition the 

 diagnosis of an acute nephritis may be made without reservation and a 

 focal nephritis or a degenerative nephrosis excluded, unless bichlorid of 

 mercury poisoning and a hypertension as the result of anuria are present." 

 These are very sweeping statements and if the differential diagnosis be- 

 tween an acute diffuse nephritis and a nephrosis depends upon the blood 

 pressure readings, of course, there is no argument against it. However, 

 the experience of some of the authors mentioned above and most clinicians 

 is that hypertension is not a constant accompaniment of acute nephritis. 

 Munk, in his recent work on nephritis, agrees with the last statement. 



Nephrosis. The degenerative lesions of the kidney have been termed 

 nephrosis to distinguish them from acute diffuse glomerulonephritis. 



