INTERSTITIAL NEPHRITIS -RENAL ABSCESS. 39 



solid spots, but merely abscesses in the kidney, surrounded by an area 

 of redness. 



SYMPTOMS AND COURSE. When not of metastatic origin, acute in- 

 terstitial nephritis, like acute inflammation of other important organs, 

 sometimes commences with a rigor. At the same time there are vio- 

 lent pains in the region of the kidney, and, in this form of renal in 

 flammation, there is a pain, which is hardly ever absent, which becomes 

 almost intolerable upon the most moderate pressure, and shoots along 

 the ureters to the bladder, and toward the testicle and thigh of the 

 affected side. The sympathetic vomiting, which we have described as 

 an almost constant accompaniment of acute parenchymatous nephritis, 

 is nearly always present also in this form of nephritis. Owing to com* 

 pression of the urinary tubules and Malpighian capsules by the inter- 

 stitial exudation, the secretion of urine is repressed. That which is 

 passed is concentrated, dark, and is often mingled with blood. The 

 fever which accompanies this disease from the outset is very apt to 

 assume a typhoid character; The patients become disturbed in mind, 

 delirious, somnolent, and fall into a state of stupor, with convulsions ; 

 symptoms which are to be ascribed to a suppression of the urine, and 

 to a surcharge of the blood with excrementitial matter. The disease 

 may terminate fatally, in the course of a few days, through general pa- 

 ralysis of the nervous system. 



The occurrence of suppuration in the kidney may be suspected 

 when the disease continues without remission, and when its course 

 is marked by numerous chills, and, above all, when pus is discharged 

 with the urine. When an abscess forms in one part of the kidney, 

 the rest of which has not been affected, or has regained its healthy 

 condition, the disease takes a more chronic course; but the fever 

 continues, and consumes the patient gradually, who almost always 

 dies sooner or later of a phthisis renalis. To detail the various modi- 

 fications of symptoms which arise from the complications of pyelitis, 

 cystitis, and the bursting of renal abscesses in various directions, 

 would lead us too far. The different courses which the matter may 

 take have already been mentioned above. There is a form of inter- 

 stitial nephritis, which is very difficult of recognition, in which the 

 substance of the kidney gradually perishes, and is replaced by a new 

 growth of connective tissue. A permanent derangement of the urinary 

 secretion, a constant desire to pass water, dull pains in the region of 

 the kidney, dropsy, great listlessness, which gradually increases to 

 coma, with other indications of the so-called uraemic poisoning, are the 

 symptoms of this form of disease, but they are very rarely properly 

 interpreted. 



Metastatic interstitial nephritis, not having any characteristic symp 

 53 



