GRANULAR DEGENERATION OF THE RENAL EPITHELIUM. 43 



symptoms, whereon to base a differential diagnosis between a sim- 

 ple parenchymatous nephritis and one which is complicated by 

 amyloid degeneration. Moreover, the difference between the two 

 conditions is a matter of but little practical interest. 



The treatment recommended for amyloid degeneration of the 

 liver and spleen is equally appropriate in amyloid disease of the 

 kidney. It is questionable whether a retrogression of the disease 

 be possible. The preparations of iron and iodide of iron may act 

 beneficially upon the primary disease, but can hardly cure a degen- 

 eration of the kidney. 



CHAPTER VIII. 



GRANULAR DEGENERATION OF THE RENAL EPITHELIUM. 



[FREQUENTLY on ^ autopsy we find the kidneys flabby, bloodless, 

 of a pale; dirty, grayish-red color, somewhat enlarged, or of normal 

 size. From their cut surface we may scrape off a cloudy grayish 

 pulp. This pulp consists of epithelial cells swollen by albuminous 

 infiltration and dotted with numerous fine granules, which render 

 the nuclei indistinct, but which vanish in the presence of potash and 

 acetic acid (thus showing that they consist of albuminous particles). 

 At a later period fat-granules may appear. When the disorder is 

 intense, the kidney becomes tender and flabby, and the epithelium 

 falls off ; but, if of only a moderate degree, the cells may undoubt- 

 edly be restored to their normal condition. Proliferation of the 

 epithelium occurs, but very rarely, and then only late in the disease. 

 Granular degeneration is not peculiar to the kidney, but is often 

 found simultaneously in the cells and tissues of the most diverse 

 organs, particularly in the liver, the heart, and the muscles. This 

 widespread appearance of the disease shows that its cause must be 

 a general one. In the bodies of persons who have died of infectious 

 diseases pyaemia, typhus, or acute miliary tuberculosis more or 

 less marked granular degeneration is found, as a result either of 

 some abnormity of the blood, or perhaps as a consequence of the 

 persistent elevation of the temperature which attends these diseases, 

 and which, according to Schultze, exercises a most pernicious in- 

 fluence upon cellular formations. But the disorder also is found 

 when there has been no fever, in chronic anaemia, chronic disease 

 of the heart or lungs, and in poisoning by phosphorus, sulphuric 

 acid, and carbonic oxide. Sometimes the cause of the granular de- 

 generation is purely local, and is limited to the kidney where it is 

 found, supplementing other morbid conditions. Very important 



