258 



REN. 



pearance of the entire organ is quite that of minish in quantity, and finally disappear ; but 



a part in a state of acute inflammation. 



When the kidney has been in a softened 

 condition before the occurrence of the inflam- 

 matory disease, as often happtns in elderly 

 persons, the lobules on the surface appear 

 larger and coarser than natural ; the veins 

 being less compressed than when the natural 

 texture of the kidney is firmer and more un- 

 yielding, are much distended with blood, so 

 that the entire organ is of a dark slate colour. 



On a microscopical examination the con- 

 voluted tubes are seen filled, in different de- 

 grees, with nucleated cells, differing in no 

 essential character from those which line the 

 tubes of the healthy gland (fig. 168). The 



Fig. 168. 



Section of a portion of inflamed kidney. The 

 tubes appear as if divided into distinct globular and 

 oval portions ; this appearance results from the man- 

 ner in which the tubes are packed in the meshes of 

 the fibrous matrix, so as to be concealed where they 

 are crossed by the fibrous tissue, and visible in the 

 intervals. The tubes are rendered opaque by an 

 accumulation of epithelium, the outline of the cells 

 being invisible on account of their being closely 

 packed. A Malpighian body in the centre of the 

 mass appears transparent and healthy. Magnified 

 200 diameters. Med. Chir. Trans, vol. xxx. 



Malpighian bodies are for the most part trans- 

 parent and healthy, but the vessels of the tuft 

 are sometimes rendered opaque by an accu- 

 mulation of small cells on their surface. Some 

 of the tubes contain blood, which has doubt- 

 less escaped from the gorged Malpighian 

 vessels. There is no deposit exterior to the 

 tubes. 



The condition of the urine in these cases 

 is clearly indicative of the process going 

 on in the kidney. After it has been allowed 

 to stand for a short time, a sediment forms ; 

 and on placing a portion of this under the 

 microscope, there may be seen blood-cor- 

 puscles, with epithelial cells in great numbers, 

 partly free and partly entangled in cylindrical 

 fibrinous casts of the urinary tubes*, and very 

 commonly numerous crystals of lithic acid 

 are present (Jig. 169). 



As the disease subsides, which under proper 

 treatment it usually does in a few clays, the 

 blood, fibrinous casts, and epithelial cells di- 



* The fibrinous moulds of the kidney tubes, as 

 seen in albuminous urine, were first observed by the 

 late Dr. F. Simon of Berlin. 



traces of the casts may be seen some days 

 after the urine has ceased to coagulate, on the 

 application of heat or nitric acid. 



Fig. 169. 



Portion of a tube much dilated and divided by 

 septa which correspond with the rings of fibrous tis- 

 sue in the microscopic specimen. See fig. 149, b. 

 The cluster about b includes two fibrinous moulds 

 of the urinary tubes, entangling epithelial cells and 

 blood corpuscles, two free epithelial cells, and three 

 crystals of lithic acid from the urine in a case of 

 " acute desquamative nephritis." 



c, A mass of oily matter from the urine. . 



d, A cluster of octohedral crystals of oxalate of 

 lime. 



Magnified 200 diameters. Med. Chir. Trans, vol. 



The changes above described as occurring 

 in the kidney are the result of a modification 

 of the natural process of secretion produced 

 by the presence of abnormal products in the 

 blood. These products are eliminated by an 

 excessive development of epithelial cells which 

 are thrown into the tubes and washed out 

 with the urine. The desquamation from the 

 inner surface of the tubes is analogous to that 

 which occurs on the skin subsequent to the 

 eruption of scarlatina. I have, therefore, pro- 

 posed to apply the term "acute desquamative 

 nephritis" to this form of disease.* 



Chronic desquamative nephritis is essentially 

 of the same nature as the acute form of the 

 disease. Its most frequent cause is the gouty 

 diathesis, and it very rarely occurs except in 

 those who are addicted to the use of alcoholic 

 drinks.f In the earlier stage of the disease 

 the kidney is of the natural size, or very 

 slightly enlarged, and the structure of the 

 organ appears confused, as if from the ad- 

 mixture of some abnormal product; there is 



* See the author's paper on this subject in the 

 Med. Chir. Trans, vol. xxx. 



f This form of diseased kidney was first described 

 by Dr. Todd, under the name of gouty kidney, in a 

 clinical lecture which was delivered in June 1846, 

 and published in the Medical Gazette for June 1847. 

 In this lecture Dr. Todd alludes particularly to the 

 destruction of the secreting cells, and the consequent 

 deficient excretion of the solid constituents of the 

 urine. 



