410 DISEASES OF THE URINARY ORGANS. 



are swollen and infiltrated with leukocytes, and their capillary 

 bloodvessels engorged. Bowman's capsule is thickened ; its 

 cells swollen, degenerated, and desquamated. The interlobular 

 arteries are more prominent than normal, and are surrounded by 

 migrated leukocytes. The leukocytic migration may be slight 

 or excessive occurring in foci or as a diffuse infiltration of 

 the cortex. In some cases, even at an early date, there is noted 

 a beginning organization of these migrated and proliferating 

 cells into more or less highly developed connective tissue. 



CHRONIC NEPHRITIS. 



Chronic nephritis may follow an acute attack, but in the 

 great majority of cases it arises insidiously as an independent 

 affection. Clinically and anatomically, two varieties of 

 chronic nephritis are recognized : one in which the changes 

 are most marked in the parenchyma of the organ, and asso- 

 ciated clinically with general dropsy and the passage of small 

 quantities of urine of low specific gravity, loaded with albu- 

 min and casts chronic parenchymatous nephritis; and the 

 other, in which the increase in connective tissue is the most 

 marked feature anatomically, and characterized clinically by 

 the absence of dropsy, and passage of large amounts of pale 

 urine containing comparatively small quantities of albumin 

 and but few casts chronic interstitial nephritis. These two 

 varieties may be different stages of one affection, but, on the 

 contrary, many cases of chronic parenchymatous nephritis 

 never go on to cirrhosis ; and often, in other instances, the 

 connective-tissue hyperplasia is the most prominent feature 

 from the earliest stages of the inflammatory process. 



In chronic parenchymatous nephritis the kidney is generally 

 enlarged, usually to a greater extent even than in acute nephri- 

 tis. The capsule is readily removed, exposing a smooth sur- 

 face, except, at a somewhat later stage, for slight irregularities 

 here and there, where bits of the parenchyma have become ad- 

 herent to the capsule and caused small lacerations on tearing it 

 away. The surface is mottled and anaemic, its pale appear- 

 ance earning for it the term large white kidney, though this 

 term is applied to amyloid degeneration, and other conditions 

 not included under the head of chronic parenchymatous 

 nephritis. In consistency the organ is doughy. 



